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General NPI Number Information
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NPI Number | 1548788003
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Entity Type | Individual
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Provider Name | ANDREA MARI CARRUTH OTR
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Gender | Female
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/05/2017
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Provider Practice Location Address
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Address Line | 4502 MEDICAL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4402
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Country | US
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Telephone | 210-386-0431
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 N STAFFORD ST.
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City | ARLINGTON
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State | VA
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Zip | 22201
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Country | US
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Telephone | 210-386-0431
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Fax |
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 0119007442
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License Number State | VA
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