Provider Demographics
NPI:1114127156
Name:SANTANA, AMY (OT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SANTANA
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 HARRY HINES BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5387
Mailing Address - Country:US
Mailing Address - Phone:214-905-9555
Mailing Address - Fax:214-905-9555
Practice Address - Street 1:6161 HARRY HINES BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5387
Practice Address - Country:US
Practice Address - Phone:214-905-9555
Practice Address - Fax:214-905-9556
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103948225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist