Provider Demographics
NPI:1598246654
Name:MARSH, MINERVA L (COTA)
Entity Type:Individual
Prefix:
First Name:MINERVA
Middle Name:L
Last Name:MARSH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7126 FM 934
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76670-1140
Mailing Address - Country:US
Mailing Address - Phone:915-244-7421
Mailing Address - Fax:
Practice Address - Street 1:400 SIDNEY RD
Practice Address - Street 2:
Practice Address - City:COMANCHE
Practice Address - State:TX
Practice Address - Zip Code:76442
Practice Address - Country:US
Practice Address - Phone:325-356-2571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213929225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontologyGroup - Single Specialty