Individual
STACIE DELEON AREVALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
310 E 18TH ST, JOSHUA, TX 76058-3117
(817) 202-2500
Mailing address
4014 BAY SPRINGS CT, ARLINGTON, TX 76016-4744
(817) 773-4554
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213102
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213102
TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS
TX
Enumeration date
07/04/2017
Last updated
03/17/2018
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