Provider Demographics
NPI:1679701874
Name:SERRANO, OLIVER JOSEPH (OTR)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:JOSEPH
Last Name:SERRANO
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 N GARDEN RIDGE BLVD
Mailing Address - Street 2:SUITE 530
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2827
Mailing Address - Country:US
Mailing Address - Phone:972-420-6605
Mailing Address - Fax:972-436-2770
Practice Address - Street 1:4897 STATE HIGHWAY 121 STE 200
Practice Address - Street 2:
Practice Address - City:THE COLONY
Practice Address - State:TX
Practice Address - Zip Code:75056-2253
Practice Address - Country:US
Practice Address - Phone:469-664-0026
Practice Address - Fax:469-664-0008
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225XH1200X
TX110973225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand