Provider Demographics
NPI:1285398461
Name:NUNEZ, MARICELLA ASHLEY (COTA)
Entity type:Individual
Prefix:MRS
First Name:MARICELLA
Middle Name:ASHLEY
Last Name:NUNEZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:MARICELLA
Other - Middle Name:ASHLEY
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21123 SWEET BLOSSOM LN
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-0442
Mailing Address - Country:US
Mailing Address - Phone:832-247-5864
Mailing Address - Fax:
Practice Address - Street 1:21123 SWEET BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-0442
Practice Address - Country:US
Practice Address - Phone:832-247-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-25
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217122224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant