Provider Demographics
NPI:1821868969
Name:CASTRO, THERESE (OTD, OTR/L)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:
Last Name:CASTRO
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:THERESE
Other - Middle Name:
Other - Last Name:FERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTD, OTR/L
Mailing Address - Street 1:1225 TRIUMPH CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7122
Mailing Address - Country:US
Mailing Address - Phone:702-350-2652
Mailing Address - Fax:
Practice Address - Street 1:1225 TRIUMPH CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7122
Practice Address - Country:US
Practice Address - Phone:702-350-2652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVOT-3364225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics