Provider Demographics
NPI:1649867318
Name:SALGADO, LIZBETH ADILENE (COTA)
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:ADILENE
Last Name:SALGADO
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 1:2135 GRANGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-5131
Mailing Address - Country:US
Mailing Address - Phone:903-503-3359
Mailing Address - Fax:
Practice Address - Street 1:2135 GRANGEWAY RD
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-5131
Practice Address - Country:US
Practice Address - Phone:903-503-3359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216519224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty