Provider Demographics
NPI:1952880742
Name:ROSALES, ANA LYDIA (COTA)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LYDIA
Last Name:ROSALES
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 1:8525 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7226
Mailing Address - Country:US
Mailing Address - Phone:956-220-1977
Mailing Address - Fax:
Practice Address - Street 1:1701 TOURNAMENT TRAIL DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6564
Practice Address - Country:US
Practice Address - Phone:956-727-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211480224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant