Provider Demographics
NPI:1285116905
Name:DOVALINA, IRIS ANNETTE (COTA)
Entity type:Individual
Prefix:
First Name:IRIS
Middle Name:ANNETTE
Last Name:DOVALINA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 MILLER AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-2954
Mailing Address - Country:US
Mailing Address - Phone:956-929-3557
Mailing Address - Fax:
Practice Address - Street 1:1812 MILLER AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2954
Practice Address - Country:US
Practice Address - Phone:956-929-3557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206574224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty