Provider Demographics
NPI:1437775087
Name:TIJERINA, ANNE LESLIE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LESLIE
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6416 US HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75672-3395
Mailing Address - Country:US
Mailing Address - Phone:903-263-9294
Mailing Address - Fax:
Practice Address - Street 1:6416 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75672-3395
Practice Address - Country:US
Practice Address - Phone:903-263-9294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-19
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101756225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics