Healthcare Provider Details

I. General information

NPI: 1831670363
Provider Name (Legal Business Name): CYNTHIA ESCAMILLA OTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2018
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SWIFT ST
REFUGIO TX
78377-2428
US

IV. Provider business mailing address

PO BOX 813
SINTON TX
78387-0813
US

V. Phone/Fax

Practice location:
  • Phone: 361-563-3642
  • Fax:
Mailing address:
  • Phone: 361-563-3642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number208269
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: