Provider Demographics
NPI:1710288345
Name:CASTANEDA, MAGALI (OTR)
Entity Type:Individual
Prefix:
First Name:MAGALI
Middle Name:
Last Name:CASTANEDA
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:PO BOX 451715
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-0042
Mailing Address - Country:US
Mailing Address - Phone:956-722-3377
Mailing Address - Fax:956-722-3892
Practice Address - Street 1:6999 MCPHERSON RD STE 212
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6450
Practice Address - Country:US
Practice Address - Phone:956-722-3377
Practice Address - Fax:956-722-3892
Is Sole Proprietor?:No
Enumeration Date:2010-11-12
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111162225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX215964503Medicaid