Provider Demographics
NPI:1629785381
Name:DE LA TORRE, LETICIA (COTA)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:DE LA TORRE
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 1:3540 COUNTY ROAD 182
Mailing Address - Street 2:
Mailing Address - City:GARRISON
Mailing Address - State:TX
Mailing Address - Zip Code:75946-5662
Mailing Address - Country:US
Mailing Address - Phone:936-221-9688
Mailing Address - Fax:
Practice Address - Street 1:3540 COUNTY ROAD 182
Practice Address - Street 2:
Practice Address - City:GARRISON
Practice Address - State:TX
Practice Address - Zip Code:75946-5662
Practice Address - Country:US
Practice Address - Phone:936-221-9688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215291224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant