Provider Demographics
NPI:1245076454
Name:TREVINO, LIANA RACHEL (OTD)
Entity type:Individual
Prefix:
First Name:LIANA
Middle Name:RACHEL
Last Name:TREVINO
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 LOU JON CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78213-3354
Mailing Address - Country:US
Mailing Address - Phone:210-216-4969
Mailing Address - Fax:
Practice Address - Street 1:634 S PRESA ST STE 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1067
Practice Address - Country:US
Practice Address - Phone:210-216-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121689225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist