Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 114215 | TX |
NPI | 1366948531 |
---|---|
Provider Name | Mariana Elizabeth Leal |
First Address | San Antonio, TX 78213-1557 |
Second Address | San Antonio, TX 78229-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2018 |
Last Update Date | 04/04/2018 |