Provider Demographics
NPI:1639345440
Name:AVILES, PATRICIA (LOT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 WESTWOOD
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-1872
Mailing Address - Country:US
Mailing Address - Phone:956-463-1210
Mailing Address - Fax:956-461-5349
Practice Address - Street 1:1145 ROSS ST
Practice Address - Street 2:SUITE K&L
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586-4421
Practice Address - Country:US
Practice Address - Phone:956-463-1210
Practice Address - Fax:956-461-5349
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108809225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist