MEDICARE: ISAEL MARQUEZ 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	109118	TX

General Provider Information

NPI Number	:	1184960197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISAEL MARQUEZ OTR

Provider Business Mailing Address
First Line	:	5632 OLD ORCHARD DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76123-5009
Country	:	US
Telephone Number	:	871-637-5736
Fax Number	:

Provider Business Practice Location Address
First Line	:	6601 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-6108
Country	:	US
Telephone Number	:	817-433-9742
Fax Number	:

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

Provider Enumeration Date	:	12/19/2012
Last Update Date	:	12/19/2012

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Directions to “ ISAEL MARQUEZ OTR” Practice Location

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