=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093938813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARCELA PINZON OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4215 JOE RAMSEY BLVD E
-----------------------------------------------------
City | GREENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75401-7852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-408-1885
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28301 STATE HIGHWAY 249 SUITE 500-308
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375-6550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-380-5155
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | OT 110991
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------