Provider Demographics
NPI:1700954104
Name:SUSTAITA, MONICA C (BS, OTR)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:C
Last Name:SUSTAITA
Suffix:
Gender:F
Credentials:BS, OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 W SCHUNIOR ST
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-2233
Mailing Address - Country:US
Mailing Address - Phone:956-984-6000
Mailing Address - Fax:956-984-7648
Practice Address - Street 1:1900 W SCHUNIOR ST
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-2233
Practice Address - Country:US
Practice Address - Phone:956-984-6000
Practice Address - Fax:956-984-7648
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110372225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454597Medicare ID - Type UnspecifiedFACILITY MDCR ID NO.