Basic Information
| Provider Information | |||||||||
| NPI: | 1891965307 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PENA | ||||||||
| FirstName: | DAISY | ||||||||
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| NamePrefix: | MRS. | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 S. JACKSON RD. | ||||||||
| Address2: | STE. 2-3 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566304400 | ||||||||
| FaxNumber: | 9566304447 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 S. JACKSON RD. | ||||||||
| Address2: | STE. 2-3 | ||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566304400 | ||||||||
| FaxNumber: | 9566304447 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 01/22/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 210019 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.