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NPI Code Detail

MEDICARE: MRS. BLANCA IVETTE MANRIQUEZ COTA/L

MEDICARE: MRS. BLANCA IVETTE MANRIQUEZ COTA/L
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 Assistant214069TX

General Provider Information

NPI Number : 1952881062
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BLANCA IVETTE MANRIQUEZ COTA/L
Provider Business Mailing Address
First Line : 3625 CLUBGATE DR
Second Line :
City : FORT WORTH
State : TX
Zip : 76137-2928
Country : US
Telephone Number : 915-373-8721
Fax Number :
Provider Business Practice Location Address
First Line : 4201 STONEGATE BLVD
Second Line :
City : FORT WORTH
State : TX
Zip : 76109-9503
Country : US
Telephone Number : 817-924-5440
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2018
Last Update Date : 08/17/2018

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Directions to “ MRS. BLANCA IVETTE MANRIQUEZ COTA/L” Practice Location

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