MEDICARE: MRS. LIZ OLGUIN LEAL 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	224Z00000X	Occupational Therapy Assistant	208248	TX
2	225X00000X	Occupational Therapist	119081	TX

General Provider Information

NPI Number	:	1134253115
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LIZ OLGUIN LEAL OTR

Provider Business Mailing Address
First Line	:	5602 ONYX WAY
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-4152
Country	:	US
Telephone Number	:	210-243-0341
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 COLORADO BLVD # 318
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-4084
Country	:	US
Telephone Number	:	866-801-9492
Fax Number	:

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	09/04/2018

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