Healthcare Provider Details

I. General information

NPI: 1962964627
Provider Name (Legal Business Name): KATHERINE CHARLES GARCIA OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 04/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9514 CONSOLE DR STE 102
SAN ANTONIO TX
78229-2042
US

IV. Provider business mailing address

21814 BURBANK HL
SAN ANTONIO TX
78256-1677
US

V. Phone/Fax

Practice location:
  • Phone: 210-448-9111
  • Fax:
Mailing address:
  • Phone: 210-823-2791
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number119838
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: