Provider Demographics
NPI:1912488396
Name:DE LEON, NELLY (COTA)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:DE LEON
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 1:716 S SALINAS BLVD
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-4002
Mailing Address - Country:US
Mailing Address - Phone:956-534-1734
Mailing Address - Fax:
Practice Address - Street 1:4503 S SUGAR RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7049
Practice Address - Country:US
Practice Address - Phone:956-386-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211740224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant