Provider Demographics
NPI:1699241737
Name:ALANIZ, JACKELINE (OTR)
Entity type:Individual
Prefix:
First Name:JACKELINE
Middle Name:
Last Name:ALANIZ
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 1:500 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2924
Mailing Address - Country:US
Mailing Address - Phone:956-687-4560
Mailing Address - Fax:956-687-4554
Practice Address - Street 1:5013 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8080
Practice Address - Country:US
Practice Address - Phone:956-686-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119447OtherOTR LICENSE