Healthcare Provider Details

I. General information

NPI: 1396224556
Provider Name (Legal Business Name): MARISSA A TIJERINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3550 N SHILOH RD
RICHARDSON TX
75082-2464
US

IV. Provider business mailing address

15850 PLUM LN
MCKINNEY TX
75070-6296
US

V. Phone/Fax

Practice location:
  • Phone: 972-231-4810
  • Fax:
Mailing address:
  • Phone: 214-326-3899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number209987
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: