Provider Demographics
NPI:1285208751
Name:MUNOZ, VICTOR ALFONSO (OTR/L)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:ALFONSO
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 W SLAUGHTER LN APT 628
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78748-2084
Mailing Address - Country:US
Mailing Address - Phone:786-367-6600
Mailing Address - Fax:
Practice Address - Street 1:715 W SLAUGHTER LN APT 628
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-2084
Practice Address - Country:US
Practice Address - Phone:786-367-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121669225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist