Provider Demographics
NPI:1154028629
Name:TAMAYO, MERCEDES MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:MARIE
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NOTRE DAME DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-5211
Mailing Address - Country:US
Mailing Address - Phone:605-786-5674
Mailing Address - Fax:
Practice Address - Street 1:10107 W MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1906
Practice Address - Country:US
Practice Address - Phone:210-267-8311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123347225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist