Individual
STEPHANIE MARIE BANUELOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
10064 ALAMEDA AVE, SOCORRO, TX 79927
(915) 773-0730
Mailing address
7825 LEDBETTER RD, VINTON, TX 79821-8607
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213408
TX
Other
Enumeration date
08/19/2018
Last updated
08/20/2018
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