Provider Demographics
NPI:1427446582
Name:PORRAS, CHRISTINA (COTA)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:
Last Name:PORRAS
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 1:311 LELIA ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75803-6855
Mailing Address - Country:US
Mailing Address - Phone:903-590-0935
Mailing Address - Fax:
Practice Address - Street 1:1816 TILE FACTORY RD
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75803-8472
Practice Address - Country:US
Practice Address - Phone:903-729-2261
Practice Address - Fax:903-729-1890
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211882224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant