Healthcare Provider Details

I. General information

NPI: 1639985625
Provider Name (Legal Business Name): MICA RUTSCHKE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9577 HUEBNER RD STE 4
SAN ANTONIO TX
78240-1688
US

IV. Provider business mailing address

803 EVIAN
SAN ANTONIO TX
78260-3578
US

V. Phone/Fax

Practice location:
  • Phone: 210-228-0030
  • Fax:
Mailing address:
  • Phone: 480-259-6785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number110994
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: