Provider Demographics
NPI:1407176662
Name:ALISANGCO, REENA POTOL (OTR)
Entity Type:Individual
Prefix:MISS
First Name:REENA
Middle Name:POTOL
Last Name:ALISANGCO
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 1:1000 E VERMONT AVE APT 1206
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1717
Mailing Address - Country:US
Mailing Address - Phone:956-789-9812
Mailing Address - Fax:
Practice Address - Street 1:920 S CLOSNER BLVD STE B
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5641
Practice Address - Country:US
Practice Address - Phone:956-287-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist