Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant |
NPI | 1003449992 |
---|---|
Provider Name | Mrs. Kristi Carrillo |
First Address | San Antonio, TX 78254-6296 |
Second Address | San Antonio, TX 78254-6296 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2020 |
Last Update Date | 19/02/2020 |