Healthcare Provider Details

I. General information

NPI: 1538657747
Provider Name (Legal Business Name): ELIZABETH JASMINE VALERA OTD, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 02/13/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

698 BASILICA BAY DR APT 8204
SPRING TX
77386-4998
US

IV. Provider business mailing address

698 BASILICA BAY DR APT 8204
SPRING TX
77386-4998
US

V. Phone/Fax

Practice location:
  • Phone: 832-788-2317
  • Fax:
Mailing address:
  • Phone: 832-788-2317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number121992
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: