Provider Demographics
NPI:1942678354
Name:CASTRO, LETICIA (COTA)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CASTRO
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 1:2117 GULL AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3926
Mailing Address - Country:US
Mailing Address - Phone:956-534-8581
Mailing Address - Fax:956-544-2569
Practice Address - Street 1:2117 GULL AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3926
Practice Address - Country:US
Practice Address - Phone:956-534-8581
Practice Address - Fax:956-544-2569
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-02
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212233224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant