Provider Demographics
NPI:1376100602
Name:HARGIS-GARZA, AMANDA KATHERINE (OTR)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:KATHERINE
Last Name:HARGIS-GARZA
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 1:8198 TWO FLS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3555
Mailing Address - Country:US
Mailing Address - Phone:210-310-8770
Mailing Address - Fax:
Practice Address - Street 1:4707 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6215
Practice Address - Country:US
Practice Address - Phone:210-691-0039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115614225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty