Provider Demographics
NPI:1518447150
Name:FLORES, RUDY JAY (MS OTR)
Entity Type:Individual
Prefix:MR
First Name:RUDY
Middle Name:JAY
Last Name:FLORES
Suffix:
Gender:M
Credentials:MS OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 N MILE 4 1/2 W
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-2380
Mailing Address - Country:US
Mailing Address - Phone:956-351-7005
Mailing Address - Fax:
Practice Address - Street 1:1814 ATRIUM PLACE DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2583
Practice Address - Country:US
Practice Address - Phone:956-230-2300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117680225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty