MEDICARE: GRISELDA BLANCO OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	114169	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003101445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRISELDA BLANCO OTR

Provider Business Mailing Address
First Line	:	5346 E US HIGHWAY 83 STE 2
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-9418
Country	:	US
Telephone Number	:	956-292-1700
Fax Number	:

Provider Business Practice Location Address
First Line	:	5346 E US HIGHWAY 83 STE 2
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-9418
Country	:	US
Telephone Number	:	956-317-1282
Fax Number	:	956-317-1282

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2011
Last Update Date	:	11/04/2023

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Directions to “ GRISELDA BLANCO OTR” Practice Location

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