Healthcare Provider Details

I. General information

NPI: 1144728668
Provider Name (Legal Business Name): MICHELE ANN MOLLEDA GREENE COTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE MOLLEDA COTA

II. Dates (important events)

Enumeration Date: 01/30/2018
Last Update Date: 06/18/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 ARCADIA PATH
SAN ANTONIO TX
78245
US

IV. Provider business mailing address

1211 ARCADIA PATH
SAN ANTONIO TX
78245
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax:
Mailing address:
  • Phone: 210-448-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number210254
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: