Provider Demographics
NPI:1821577651
Name:YARRITO, JULISSA (COTA)
Entity Type:Individual
Prefix:
First Name:JULISSA
Middle Name:
Last Name:YARRITO
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 1:500 EBONY ST
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-2342
Mailing Address - Country:US
Mailing Address - Phone:956-961-5724
Mailing Address - Fax:
Practice Address - Street 1:2418 BUDDY OWENS AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5463
Practice Address - Country:US
Practice Address - Phone:956-630-2850
Practice Address - Fax:956-687-5638
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211846224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX211846OtherTBOTE