Provider Demographics
NPI:1396028833
Name:SANTIAGO, SOPHIA JULIE-ANN (OTR)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:JULIE-ANN
Last Name:SANTIAGO
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 1:3463 MAGIC DR
Mailing Address - Street 2:SUITE 255
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2973
Mailing Address - Country:US
Mailing Address - Phone:210-582-5840
Mailing Address - Fax:210-582-5841
Practice Address - Street 1:3463 MAGIC DR
Practice Address - Street 2:SUITE 255
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-2973
Practice Address - Country:US
Practice Address - Phone:210-582-5840
Practice Address - Fax:210-582-5841
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113080225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist