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NPI Code Detail

MEDICARE: MS. THALIA TREVINO OTA

MEDICARE: MS. THALIA TREVINO OTA
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
1224Z00000XOccupational Therapy Assistant209787TX

General Provider Information

NPI Number : 1710262027
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. THALIA TREVINO OTA
Provider Business Mailing Address
First Line : 6942 SAHARASTONE DR
Second Line :
City : CONVERSE
State : TX
Zip : 78109-3473
Country : US
Telephone Number : 210-788-3289
Fax Number :
Provider Business Practice Location Address
First Line : 15911 NACOGDOCHES RD
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-1107
Country : US
Telephone Number : 210-599-7733
Fax Number : 210-599-3105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2011
Last Update Date : 10/18/2011

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