Healthcare Provider Details

I. General information

NPI: 1740465186
Provider Name (Legal Business Name): TEODORO TREVINO JR. O.T.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 03/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W SESAME DR
HARLINGEN TX
78550-7930
US

IV. Provider business mailing address

221 MORELOS AVE
RANCHO VIEJO TX
78575-9514
US

V. Phone/Fax

Practice location:
  • Phone: 956-399-4500
  • Fax:
Mailing address:
  • Phone: 956-621-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number111870
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: