Healthcare Provider Details

I. General information

NPI: 1558790642
Provider Name (Legal Business Name): RUHAMA BESTAVROS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9910 HUEBNER RD SUITE 200
SAN ANTONIO TX
78240-1342
US

IV. Provider business mailing address

1495 NW GILMAN BLVD SUITE 4
ISSAQUAH WA
98027
US

V. Phone/Fax

Practice location:
  • Phone: 210-691-0039
  • Fax: 210-699-0136
Mailing address:
  • Phone: 210-691-0039
  • Fax: 210-699-0136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number115578
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: