Provider Demographics
NPI:1295938942
Name:MAZAL, ROSLYN M (OTR)
Entity type:Individual
Prefix:
First Name:ROSLYN
Middle Name:M
Last Name:MAZAL
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 1:202 W SUNSET RD # B
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2635
Mailing Address - Country:US
Mailing Address - Phone:210-402-4077
Mailing Address - Fax:210-402-2922
Practice Address - Street 1:202 W SUNSET RD # B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2635
Practice Address - Country:US
Practice Address - Phone:210-402-4077
Practice Address - Fax:210-402-2922
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100688225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T3098OtherBCBS