Provider Demographics
NPI:1952907552
Name:REYNA, SANDRA MICHELLE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:MICHELLE
Last Name:REYNA
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10735 RIVERA CV
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3918
Mailing Address - Country:US
Mailing Address - Phone:956-600-5468
Mailing Address - Fax:
Practice Address - Street 1:823 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-1625
Practice Address - Country:US
Practice Address - Phone:210-888-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116786225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty