Provider Demographics
NPI:1023725256
Name:VRLA, TABATHA SHAE (COTA)
Entity type:Individual
Prefix:
First Name:TABATHA
Middle Name:SHAE
Last Name:VRLA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2701 AIRPORT FWY STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-2378
Mailing Address - Country:US
Mailing Address - Phone:682-564-5476
Mailing Address - Fax:
Practice Address - Street 1:4365 S HULEN ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-4917
Practice Address - Country:US
Practice Address - Phone:817-238-3033
Practice Address - Fax:682-292-2930
Is Sole Proprietor?:No
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant