Provider Demographics
NPI:1477066066
Name:CARRILLO, HECTOR LORENZO JR (OT)
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:LORENZO
Last Name:CARRILLO
Suffix:JR
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 MESCAL LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8498
Mailing Address - Country:US
Mailing Address - Phone:915-545-3422
Mailing Address - Fax:
Practice Address - Street 1:4601 HONDO PASS DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-1457
Practice Address - Country:US
Practice Address - Phone:915-545-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115387225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist