Provider Demographics
NPI:1649841719
Name:SCUADRONI, ANIBAL G JR (COTA/L)
Entity type:Individual
Prefix:MR
First Name:ANIBAL
Middle Name:G
Last Name:SCUADRONI
Suffix:JR
Gender:M
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 WATERSIDE VILLAGE DR APT 128
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-6914
Mailing Address - Country:US
Mailing Address - Phone:845-597-5479
Mailing Address - Fax:
Practice Address - Street 1:107 E ROGERS ST
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:TX
Practice Address - Zip Code:77962-8420
Practice Address - Country:US
Practice Address - Phone:361-771-3315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216807224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant