Healthcare Provider Details

I. General information

NPI: 1730967340
Provider Name (Legal Business Name): AMY JO CORRAL OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14207 HIGGINS RD
SAN ANTONIO TX
78217-1252
US

IV. Provider business mailing address

23139 TREEMONT PARK
SAN ANTONIO TX
78261-2824
US

V. Phone/Fax

Practice location:
  • Phone: 210-826-4492
  • Fax:
Mailing address:
  • Phone: 210-906-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number124020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: