Provider Demographics
NPI:1124701610
Name:MENDOZA, CELESTE (OTR)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:MENDOZA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 852647
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75085-2647
Mailing Address - Country:US
Mailing Address - Phone:972-454-9309
Mailing Address - Fax:
Practice Address - Street 1:3626 N MACARTHUR BLVD STE 225
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3663
Practice Address - Country:US
Practice Address - Phone:469-498-3778
Practice Address - Fax:972-338-9378
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123735225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist