Basic Information
| Provider Information | |||||||||
| NPI: | 1811471238 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DEVERTER | ||||||||
| FirstName: | KARA | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25602 SAGO PALM | ||||||||
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| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782612464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129056274 | ||||||||
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| Practice Location | |||||||||
| Address1: | 615 FALTIN ST | ||||||||
| Address2: | |||||||||
| City: | COMFORT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8309953747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2018 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 215335 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.