Provider Demographics
NPI:1316100340
Name:MANCHA, YADIRA DENISSE (OTR)
Entity type:Individual
Prefix:
First Name:YADIRA
Middle Name:DENISSE
Last Name:MANCHA
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 1:3517 KINGSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6191
Mailing Address - Country:US
Mailing Address - Phone:956-802-2891
Mailing Address - Fax:
Practice Address - Street 1:1922 E GRIFFIN PKWY STE G
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3110
Practice Address - Country:US
Practice Address - Phone:956-802-2891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112481225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist