Provider Demographics
NPI:1588144968
Name:MORALEZ, SUSAN MARIE (COTA)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARIE
Last Name:MORALEZ
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 1:1309 ADAMS DR
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-1520
Mailing Address - Country:US
Mailing Address - Phone:956-533-9788
Mailing Address - Fax:
Practice Address - Street 1:313 W HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:LA FERIA
Practice Address - State:TX
Practice Address - Zip Code:78559-5116
Practice Address - Country:US
Practice Address - Phone:956-797-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX213465224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant