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General NPI Number Information
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NPI Number | 1114185683
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Entity Type | Organization
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Legal Business Name | FOREVER HEALTH
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Dates
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Enumeration Date | 05/30/2008
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 202 W SUNSET RD SUITE B
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City | SAN ANTONIO
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State | TX
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Zip | 78209-2635
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Country | US
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Telephone | 210-402-4077
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Fax |
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Provider Business Mailing Address
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Address Line | 202 W SUNSET RD SUITE B
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City | SAN ANTONIO
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State | TX
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Zip | 78209-2635
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Country | US
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Telephone | 210-402-4077
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSLYN M. MAZAL
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Credential | OTR/LLC
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Telephone | 210-402-4077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 100688
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License Number State | TX
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