Provider Demographics
NPI:1356099824
Name:LEAL, ANGELICA ESTELA (MSOT, OTR)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:ESTELA
Last Name:LEAL
Suffix:
Gender:F
Credentials:MSOT, OTR
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11031 GENEVA MOON
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5552
Mailing Address - Country:US
Mailing Address - Phone:210-290-4625
Mailing Address - Fax:
Practice Address - Street 1:400 E QUINCY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1934
Practice Address - Country:US
Practice Address - Phone:210-472-0211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122570225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist