Healthcare Provider Details

I. General information

NPI: 1588975775
Provider Name (Legal Business Name): SARA BETH MAIER OT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4206 RETAMA CIR
VICTORIA TX
77901-2765
US

IV. Provider business mailing address

PO BOX 5171
VICTORIA TX
77903-5171
US

V. Phone/Fax

Practice location:
  • Phone: 361-582-0602
  • Fax: 361-582-4805
Mailing address:
  • Phone: 361-582-0602
  • Fax: 361-582-4805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number109563
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: