Provider Demographics
NPI:1104242015
Name:VALDERAS, MARY ANNA (OT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNA
Last Name:VALDERAS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3081 STARWASHED DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5476
Mailing Address - Country:US
Mailing Address - Phone:214-478-6293
Mailing Address - Fax:
Practice Address - Street 1:3081 STARWASHED DR
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:TX
Practice Address - Zip Code:76065-5476
Practice Address - Country:US
Practice Address - Phone:214-478-6293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-16
Last Update Date:2014-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104611251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health