Provider Demographics
NPI:1841072733
Name:MARIN, GRACIELA (AAS)
Entity type:Individual
Prefix:
First Name:GRACIELA
Middle Name:
Last Name:MARIN
Suffix:
Gender:F
Credentials:AAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065
Mailing Address - Country:US
Mailing Address - Phone:806-669-2551
Mailing Address - Fax:
Practice Address - Street 1:832 E CRAVEN AVE
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-7517
Practice Address - Country:US
Practice Address - Phone:806-669-2551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216985224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant