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NPI Code Detail

MEDICARE: FABIOLA BELTRAN OTA, COTA

MEDICARE: FABIOLA BELTRAN OTA, COTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224Z00000XOccupational Therapy Assistant217769TX

General Provider Information

NPI Number : 1053010306
Entity Type Code : Individual
Provider Name (Legal Business Name) : FABIOLA BELTRAN OTA, COTA
Provider Business Mailing Address
First Line : 2516 WINTER OAK ST
Second Line :
City : DALLAS
State : TX
Zip : 75227-7658
Country : US
Telephone Number : 214-664-7765
Fax Number :
Provider Business Practice Location Address
First Line : 4775 NORTH FWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76106-2300
Country : US
Telephone Number : 682-738-3056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2023
Last Update Date : 02/27/2023

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