Provider Demographics
NPI:1871072538
Name:MORA, MARIE JEANNETTE SALVADOR (OTR)
Entity type:Individual
Prefix:
First Name:MARIE JEANNETTE
Middle Name:SALVADOR
Last Name:MORA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10127 HUEBNER RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1320
Mailing Address - Country:US
Mailing Address - Phone:210-858-0828
Mailing Address - Fax:210-858-7838
Practice Address - Street 1:10127 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1320
Practice Address - Country:US
Practice Address - Phone:210-858-0828
Practice Address - Fax:210-858-0838
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
TX108594225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist