Provider Demographics
NPI:1821463233
Name:VILLARREAL VERGARA, LAURA LIZETH (COTA)
Entity Type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:LIZETH
Last Name:VILLARREAL VERGARA
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 1:5910 SAN BERNARDO AVE APT 173
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2520
Mailing Address - Country:US
Mailing Address - Phone:956-774-2297
Mailing Address - Fax:
Practice Address - Street 1:305 NE LOOP 820; BUSINESS TOWER 1
Practice Address - Street 2:SUITE 200; HURST, TX 76053
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:76053
Practice Address - Country:US
Practice Address - Phone:817-292-8787
Practice Address - Fax:817-789-6849
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-10
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213388224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant