Provider Demographics
NPI:1679770226
Name:CARRANZA, NICOLE ALICIA (MOTR)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ALICIA
Last Name:CARRANZA
Suffix:
Gender:F
Credentials:MOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7516 N 2ND LN
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5682
Mailing Address - Country:US
Mailing Address - Phone:956-525-2020
Mailing Address - Fax:956-682-6536
Practice Address - Street 1:7516 N 2ND LN
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5682
Practice Address - Country:US
Practice Address - Phone:956-525-2020
Practice Address - Fax:956-682-6536
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112204225X00000X, 251C00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No251C00000XAgenciesDay Training, Developmentally Disabled Services