MEDICARE: DAWN THERESA VIGUE 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	119983	TX

General Provider Information

NPI Number	:	1306499173
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN THERESA VIGUE OTR

Provider Business Mailing Address
First Line	:	21626 STONEWALL PKWY APT 4402
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-1724
Country	:	US
Telephone Number	:	860-995-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	21626 STONEWALL PKWY APT 4402
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78256-1724
Country	:	US
Telephone Number	:	860-995-3766
Fax Number	:

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

Provider Enumeration Date	:	07/22/2019
Last Update Date	:	07/22/2019

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Directions to “ DAWN THERESA VIGUE OTR” Practice Location

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