Provider Demographics
NPI:1093462954
Name:CUELLAR, ALEXANDER (MS, OT)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:MS, OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3348
Mailing Address - Country:US
Mailing Address - Phone:956-227-2110
Mailing Address - Fax:
Practice Address - Street 1:2504 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3348
Practice Address - Country:US
Practice Address - Phone:956-227-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122305225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist