Provider Demographics
NPI:1679037345
Name:CHAVEZ, MARIA SELENA CRUZ (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARIA SELENA
Middle Name:CRUZ
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11623 BRENTCROSS DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-1180
Mailing Address - Country:US
Mailing Address - Phone:936-229-7833
Mailing Address - Fax:
Practice Address - Street 1:11830 NORTHPOINTE BLVD
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-5536
Practice Address - Country:US
Practice Address - Phone:281-205-9453
Practice Address - Fax:281-516-9185
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112430225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112430OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS