Provider Demographics
NPI:1194967133
Name:ACOSTA, MARIA LISA (OTR)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LISA
Last Name:ACOSTA
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 1:5690 SANTA TERESITA DR
Mailing Address - Street 2:STE. A-1
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9206
Mailing Address - Country:US
Mailing Address - Phone:915-603-5019
Mailing Address - Fax:866-830-3399
Practice Address - Street 1:1700 N ZARAGOZA RD
Practice Address - Street 2:STE 118
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7963
Practice Address - Country:US
Practice Address - Phone:915-603-5019
Practice Address - Fax:866-830-3399
Is Sole Proprietor?:No
Enumeration Date:2009-04-06
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112052225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist