Healthcare Provider Details

I. General information

NPI: 1679713952
Provider Name (Legal Business Name): ELSA ESCOBEDO-LOPEZ O.T.R,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2009
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12732 OLD SPANISH TRL
LIVE OAK TX
78233-2526
US

IV. Provider business mailing address

12732 OLD SPANISH TRL
LIVE OAK TX
78233-2526
US

V. Phone/Fax

Practice location:
  • Phone: 210-857-0317
  • Fax:
Mailing address:
  • Phone: 210-857-0317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number102700
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: