Provider Demographics
NPI:1982422812
Name:CULBERTSON, RONALD (COTA)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:
Last Name:CULBERTSON
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14011 PERSIMMON CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4492
Mailing Address - Country:US
Mailing Address - Phone:937-430-6690
Mailing Address - Fax:
Practice Address - Street 1:102 PALO ALTO RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78211-3773
Practice Address - Country:US
Practice Address - Phone:210-922-1785
Practice Address - Fax:210-922-1782
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218571224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant