=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699241737
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JACKELINE ALANIZ OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2018
-----------------------------------------------------
Last Update Date | 10/16/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5013 S MCCOLL RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78539-8080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-686-8485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 LINDBERG AVE
-----------------------------------------------------
City | MCALLEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78501-2924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-687-4560
-----------------------------------------------------
Fax | 956-687-4554
-----------------------------------------------------
=====================================================
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 |
-----------------------------------------------------
License Number State |
-----------------------------------------------------