Provider Demographics
NPI:1023245297
Name:VALLEJO, ROSIE ISELA (OTR)
Entity type:Individual
Prefix:
First Name:ROSIE
Middle Name:ISELA
Last Name:VALLEJO
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 1:2513 EMORY AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5730
Mailing Address - Country:US
Mailing Address - Phone:956-624-6468
Mailing Address - Fax:
Practice Address - Street 1:800 S 16TH 1/2 ST STE 20
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5263
Practice Address - Country:US
Practice Address - Phone:956-328-5424
Practice Address - Fax:844-272-6959
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118877225X00000X
TX208964224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3796575Medicaid