Provider Demographics
NPI:1912126756
Name:LEAL, CHRISELDA L (OTR)
Entity Type:Individual
Prefix:MRS
First Name:CHRISELDA
Middle Name:L
Last Name:LEAL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:CHRISELDA
Other - Middle Name:L
Other - Last Name:CASTILLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR
Mailing Address - Street 1:PO BOX 4132
Mailing Address - Street 2:
Mailing Address - City:EDCOUCH
Mailing Address - State:TX
Mailing Address - Zip Code:78538-4132
Mailing Address - Country:US
Mailing Address - Phone:956-789-1789
Mailing Address - Fax:
Practice Address - Street 1:601 N MILE 2 W
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570
Practice Address - Country:US
Practice Address - Phone:956-294-1809
Practice Address - Fax:956-294-1987
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108539225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist