Provider Demographics
NPI:1245956549
Name:MAXINEAU, EDNICA (OTR/L)
Entity type:Individual
Prefix:
First Name:EDNICA
Middle Name:
Last Name:MAXINEAU
Suffix:
Gender:
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 1:103 BLANCO WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-5819
Mailing Address - Country:US
Mailing Address - Phone:347-447-7946
Mailing Address - Fax:
Practice Address - Street 1:103 BLANCO WOODS BLVD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-5819
Practice Address - Country:US
Practice Address - Phone:347-447-7946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125155225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist