Provider Demographics
NPI:1689982514
Name:VILLANUEVA, ELBA JANNETTE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:ELBA
Middle Name:JANNETTE
Last Name:VILLANUEVA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MRS
Other - First Name:ELBA
Other - Middle Name:J
Other - Last Name:VILLANUEVA CLASS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:1301 JUSTIN RD STE 206
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75077-2150
Mailing Address - Country:US
Mailing Address - Phone:972-317-7775
Mailing Address - Fax:972-317-6356
Practice Address - Street 1:1301 JUSTIN RD STE 206
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75077-2150
Practice Address - Country:US
Practice Address - Phone:972-317-7775
Practice Address - Fax:972-317-6356
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR445225X00000X
TX117363225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist