Provider Demographics
NPI:1871010959
Name:VARELA, LORA MARIE (COTA)
Entity Type:Individual
Prefix:
First Name:LORA
Middle Name:MARIE
Last Name:VARELA
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 1:1431 CAP RIDGE PEAK
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3473
Mailing Address - Country:US
Mailing Address - Phone:830-305-4236
Mailing Address - Fax:
Practice Address - Street 1:562 SOUTH HIGHWAY 123 BYPASS
Practice Address - Street 2:224
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155
Practice Address - Country:US
Practice Address - Phone:210-215-1840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211683224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$Medicaid
$$$$$$$$$OtherBLUE CROSS