Provider Demographics
NPI:1649771411
Name:NAVARRO, MARIAN LESLIE (COTA)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:LESLIE
Last Name:NAVARRO
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 1:9505 BENTLEY GARNER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-3039
Mailing Address - Country:US
Mailing Address - Phone:956-778-1231
Mailing Address - Fax:
Practice Address - Street 1:2100 E MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-1342
Practice Address - Country:US
Practice Address - Phone:512-900-7934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212240224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant