Provider Demographics
NPI:1528244340
Name:VARGAS, CHRISELDA MICHELLE (COTA)
Entity type:Individual
Prefix:
First Name:CHRISELDA
Middle Name:MICHELLE
Last Name:VARGAS
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 1:1001 LOUISIANA AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-2833
Mailing Address - Country:US
Mailing Address - Phone:361-853-0488
Mailing Address - Fax:361-853-0489
Practice Address - Street 1:1001 LOUISIANA AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-2833
Practice Address - Country:US
Practice Address - Phone:361-853-0488
Practice Address - Fax:361-853-0489
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist