Provider Demographics
NPI:1851737936
Name:MORENO, ROSY S (COTA)
Entity Type:Individual
Prefix:
First Name:ROSY
Middle Name:S
Last Name:MORENO
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 1:1005 E NOLANA AVE
Mailing Address - Street 2:STE. C
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6101
Mailing Address - Country:US
Mailing Address - Phone:956-630-6300
Mailing Address - Fax:956-630-3443
Practice Address - Street 1:1005 E NOLANA AVE
Practice Address - Street 2:STE. C
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6101
Practice Address - Country:US
Practice Address - Phone:956-630-6300
Practice Address - Fax:956-630-3443
Is Sole Proprietor?:No
Enumeration Date:2013-05-16
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209579224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX167033301Medicaid