MEDICARE: LETICIA CASTILLO 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	111496	TX

General Provider Information

NPI Number	:	1760640882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LETICIA CASTILLO OTR

Provider Business Mailing Address
First Line	:	1558 CASTILLO LN
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6205
Country	:	US
Telephone Number	:	956-735-9806
Fax Number	:

Provider Business Practice Location Address
First Line	:	1558 CASTILLO LN
Second Line	:
City	:	RIO GRANDE CITY
State	:	TX
Zip	:	78582-6205
Country	:	US
Telephone Number	:	956-735-9806
Fax Number	:

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	05/27/2008

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