Provider Demographics
NPI:1639636178
Name:BAZALDUA, ARIADNE (OTR)
Entity Type:Individual
Prefix:
First Name:ARIADNE
Middle Name:
Last Name:BAZALDUA
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 1:109 W EAGLE AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-9006
Mailing Address - Country:US
Mailing Address - Phone:210-446-7667
Mailing Address - Fax:
Practice Address - Street 1:109 W EAGLE AVE
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-9006
Practice Address - Country:US
Practice Address - Phone:210-446-7667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2022-08-07
Deactivation Date:2021-07-04
Deactivation Code:
Reactivation Date:2022-08-03
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist