Provider Demographics
NPI:1023262011
Name:DIAZ, OLGA (OTR)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:DIAZ
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 1:3001 MYNAH AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-6020
Mailing Address - Country:US
Mailing Address - Phone:956-867-1668
Mailing Address - Fax:956-580-0088
Practice Address - Street 1:3001 MYNAH AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6020
Practice Address - Country:US
Practice Address - Phone:956-867-1668
Practice Address - Fax:956-580-0088
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist