Provider Demographics
NPI:1184618159
Name:HUBER, THERESA ANN (OTR)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:ANN
Last Name:HUBER
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 640967
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904
Mailing Address - Country:US
Mailing Address - Phone:915-626-8402
Mailing Address - Fax:915-755-5334
Practice Address - Street 1:6955 N. MESA
Practice Address - Street 2:SUITE 301 C
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912
Practice Address - Country:US
Practice Address - Phone:915-626-8402
Practice Address - Fax:915-755-5334
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-18
Provider Licenses
StateLicense IDTaxonomies
TX102021225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX653035Medicare ID - Type UnspecifiedOCCUPATIONAL THERAPY