Provider Demographics
NPI:1841904844
Name:LLESIS, TRISHA MAE HERNANDEZ
Entity type:Individual
Prefix:
First Name:TRISHA MAE
Middle Name:HERNANDEZ
Last Name:LLESIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23423 HIGHWAY 59 N APT 2604
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-1557
Mailing Address - Country:US
Mailing Address - Phone:346-404-4457
Mailing Address - Fax:
Practice Address - Street 1:23423 HIGHWAY 59 N APT 2604
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-1557
Practice Address - Country:US
Practice Address - Phone:346-404-4457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX217734224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant