Provider Demographics
NPI:1205321825
Name:MENCHACA, KARLA YADIRA (OT)
Entity type:Individual
Prefix:
First Name:KARLA
Middle Name:YADIRA
Last Name:MENCHACA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 CHESTNUT KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-5276
Mailing Address - Country:US
Mailing Address - Phone:956-346-4357
Mailing Address - Fax:
Practice Address - Street 1:4706 AIRPORT AVE STE A
Practice Address - Street 2:
Practice Address - City:ROSENBERG
Practice Address - State:TX
Practice Address - Zip Code:77471-5645
Practice Address - Country:US
Practice Address - Phone:281-238-1800
Practice Address - Fax:281-239-0828
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121919225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty