Provider Demographics
NPI:1417478512
Name:MADRID, DINA MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:DINA
Middle Name:MARIE
Last Name:MADRID
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:DINA
Other - Middle Name:MARIE
Other - Last Name:MADRID
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7366 BRAYS LANDING DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-3101
Mailing Address - Country:US
Mailing Address - Phone:915-241-3541
Mailing Address - Fax:
Practice Address - Street 1:7760 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-3136
Practice Address - Country:US
Practice Address - Phone:915-887-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108205225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist