Provider Demographics
NPI:1518201086
Name:NASTRO, MARY ANN (OTR)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:NASTRO
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 1:4419 SAN FERNANDO LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-4401
Mailing Address - Country:US
Mailing Address - Phone:972-529-5705
Mailing Address - Fax:505-468-9012
Practice Address - Street 1:4419 SAN FERNANDO LN
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-4401
Practice Address - Country:US
Practice Address - Phone:972-529-5705
Practice Address - Fax:505-468-9012
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104650225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist