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Individual

DR. LYDDIA REVELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DSC

Contact information

Practice address
3551 ROGER BROOKE DR, JBSA FT SAM HOUSTON, TX 78234
(262) 501-9788
Mailing address
419 BELMONT UNIT 1, SAN ANTONIO, TX 78202-3135
(262) 501-9788

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5857-26
WI

Other

Enumeration date
06/13/2016
Last updated
05/01/2023
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