Provider Demographics
NPI:1043791643
Name:SIFUENTES, ELEANOR GALAVIZ (LOTA)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:GALAVIZ
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:LOTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8417 PANADERO DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2745
Mailing Address - Country:US
Mailing Address - Phone:469-834-7719
Mailing Address - Fax:
Practice Address - Street 1:1700 ONION CREEK PKWY
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-1948
Practice Address - Country:US
Practice Address - Phone:512-291-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208819224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant