Individual
EDWARD SANTIAGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 SUMMIT AVE, APT 414, FORT WORTH, TX 76102-2618
(682) 730-0004
Mailing address
3001 WREN LN, MIDLOTHIAN, TX 76065-6797
(972) 921-1833
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210931
TX
Other
Enumeration date
05/01/2015
Last updated
05/01/2015
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