Provider Demographics
NPI:1780401109
Name:VILLEGAS, MANUELA (OTR)
Entity type:Individual
Prefix:
First Name:MANUELA
Middle Name:
Last Name:VILLEGAS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MANUELA
Other - Middle Name:
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:5220 SPRING VALLEY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-2512
Mailing Address - Country:US
Mailing Address - Phone:214-466-1340
Mailing Address - Fax:214-466-1378
Practice Address - Street 1:4444 CORONA DR STE 144
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4322
Practice Address - Country:US
Practice Address - Phone:361-854-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110068225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist