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General NPI Number Information
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NPI Number | 1245973833
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Entity Type | Individual
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Provider Name | MARIA TERESA TEJADA OTA
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Gender | Female
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 3712 NEW MATHIS RD STE 104
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City | ELMENDORF
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State | TX
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Zip | 78112-6276
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Country | US
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Telephone | 210-757-3021
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Fax |
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Provider Business Mailing Address
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Address Line | 3712 NEW MATHIS RD STE 104
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City | ELMENDORF
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State | TX
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Zip | 78112-6276
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Country | US
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Telephone | 210-757-3021
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Fax | 210-922-1782
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 217264
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License Number State | TX
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