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General NPI Number Information
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NPI Number | 1619459666
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Entity Type | Individual
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Provider Name | SANAMI ANN FOTTRAL
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 101 W GOODWIN AVE STE 600
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City | VICTORIA
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State | TX
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Zip | 77901-6530
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Country | US
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Telephone | 361-572-0784
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Fax |
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Provider Business Mailing Address
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Address Line | 1107 E QUINCY ST
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4517
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Country | US
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Telephone |
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 114325
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License Number State | TX
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