Provider Demographics
NPI:1679713952
Name:ESCOBEDO-LOPEZ, ELSA (OTR,)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:
Last Name:ESCOBEDO-LOPEZ
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 1:12732 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-2526
Mailing Address - Country:US
Mailing Address - Phone:210-857-0317
Mailing Address - Fax:
Practice Address - Street 1:12732 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-2526
Practice Address - Country:US
Practice Address - Phone:210-857-0317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-26
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102700225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX825T90OtherBLUE CROSS BLUE SHEILD