Provider Demographics
NPI:1821493925
Name:HUERTA, KEYSA LYNNE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KEYSA
Middle Name:LYNNE
Last Name:HUERTA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:KEYSA
Other - Middle Name:LYNNE
Other - Last Name:JOHANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:1513 NW 23RD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-1305
Mailing Address - Country:US
Mailing Address - Phone:918-361-4469
Mailing Address - Fax:
Practice Address - Street 1:1513 NW 23RD ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-1305
Practice Address - Country:US
Practice Address - Phone:918-361-4469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113372225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation