Provider Demographics
NPI:1063266245
Name:DE LA O, ODALYS MAITE (OTR)
Entity type:Individual
Prefix:
First Name:ODALYS
Middle Name:MAITE
Last Name:DE LA O
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 1:295 COUNTY ROAD 138 APT 13308
Mailing Address - Street 2:
Mailing Address - City:HUTTO
Mailing Address - State:TX
Mailing Address - Zip Code:78634-2443
Mailing Address - Country:US
Mailing Address - Phone:956-250-9595
Mailing Address - Fax:
Practice Address - Street 1:2300 LOUIS HENNA BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2083
Practice Address - Country:US
Practice Address - Phone:512-649-1464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist