Provider Demographics
NPI:1134536485
Name:MUNOZ, MICKAELA (COTA)
Entity type:Individual
Prefix:MRS
First Name:MICKAELA
Middle Name:
Last Name:MUNOZ
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:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:BOVINA
Mailing Address - State:TX
Mailing Address - Zip Code:79009-0093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:409 4TH ST
Practice Address - Street 2:
Practice Address - City:BOVINA
Practice Address - State:TX
Practice Address - Zip Code:79009-0093
Practice Address - Country:US
Practice Address - Phone:575-791-5063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210586224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant