Healthcare Provider Details

I. General information

NPI: 1437775087
Provider Name (Legal Business Name): ANNE LESLIE TIJERINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2020
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6416 US HIGHWAY 80 E
MARSHALL TX
75672-3395
US

IV. Provider business mailing address

6416 US HIGHWAY 80 E
MARSHALL TX
75672-3395
US

V. Phone/Fax

Practice location:
  • Phone: 903-263-9294
  • Fax:
Mailing address:
  • Phone: 903-263-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number101756
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: