Provider Demographics
NPI:1669953832
Name:VIDAL, SABRINA STEPHANIE (COTA)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:STEPHANIE
Last Name:VIDAL
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 1:8618 LUDLOW CV
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3672
Mailing Address - Country:US
Mailing Address - Phone:210-396-1496
Mailing Address - Fax:
Practice Address - Street 1:9903 HUNTERS POND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224
Practice Address - Country:US
Practice Address - Phone:210-477-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214720224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant