Healthcare Provider Details

I. General information

NPI: 1578845871
Provider Name (Legal Business Name): AURORA TREVINO OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6996 S ZARZAMORA ST STE A
SAN ANTONIO TX
78224-1126
US

IV. Provider business mailing address

2660 COMMON ST STE. 101
NEW BRAUNFELS TX
78130-3584
US

V. Phone/Fax

Practice location:
  • Phone: 210-787-1583
  • Fax: 210-921-0009
Mailing address:
  • Phone: 210-787-1583
  • Fax: 210-921-0009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number107433
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: