Provider Demographics
NPI:1578851499
Name:DE LA GARZA, DONNA HAYLOCK (OTR)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:HAYLOCK
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3105
Mailing Address - Country:US
Mailing Address - Phone:956-519-2500
Mailing Address - Fax:956-519-2520
Practice Address - Street 1:2334 BOCA CHICA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2669
Practice Address - Country:US
Practice Address - Phone:956-214-8023
Practice Address - Fax:956-214-8022
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114293225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist