Provider Demographics
NPI:1750862363
Name:FONTS, SARINA OLIVIA (OTA)
Entity Type:Individual
Prefix:
First Name:SARINA
Middle Name:OLIVIA
Last Name:FONTS
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16201 ROUGH OAK ST APT 1721
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1858
Mailing Address - Country:US
Mailing Address - Phone:904-993-7918
Mailing Address - Fax:
Practice Address - Street 1:913 US HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:CASTROVILLE
Practice Address - State:TX
Practice Address - Zip Code:78009-3853
Practice Address - Country:US
Practice Address - Phone:830-931-2900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214877224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX528748194Medicaid