Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 001303 | TX |
NPI | 1336125699 |
---|---|
Provider Name | Amy Jane Castillo |
First Address | Schertz, TX 78154-1951 |
Second Address | Jbsa Ft Sam Houston, TX 78234-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 07/04/2020 |