Provider Demographics
NPI:1891965307
Name:PENA, DAISY (COTA)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:
Last Name:PENA
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 1:1900 S. JACKSON RD.
Mailing Address - Street 2:STE. 2-3
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503
Mailing Address - Country:US
Mailing Address - Phone:956-630-4400
Mailing Address - Fax:956-630-4447
Practice Address - Street 1:1900 S. JACKSON RD.
Practice Address - Street 2:STE. 2-3
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-630-4400
Practice Address - Fax:956-630-4447
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210019224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant