Provider Demographics
NPI:1457904393
Name:CLAUDIO, ISAEL (COTA)
Entity Type:Individual
Prefix:
First Name:ISAEL
Middle Name:
Last Name:CLAUDIO
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820; BUSINESS TOWER 1; SUITE 200
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:78046
Mailing Address - Country:US
Mailing Address - Phone:956-285-5430
Mailing Address - Fax:
Practice Address - Street 1:305 NE LOOP 820; BUSINESS TOWER 1; SUITE 200
Practice Address - Street 2:
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:78046
Practice Address - Country:US
Practice Address - Phone:817-292-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215832224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215832OtherECOTE