Provider Demographics
NPI:1043567852
Name:REYES-CUERVA, CARLA SUAREZ (OT,CHT)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:SUAREZ
Last Name:REYES-CUERVA
Suffix:
Gender:F
Credentials:OT,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5455 N MARTY AVE
Mailing Address - Street 2:APT. #113
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-6551
Mailing Address - Country:US
Mailing Address - Phone:559-960-6340
Mailing Address - Fax:
Practice Address - Street 1:7005 N MAPLE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8009
Practice Address - Country:US
Practice Address - Phone:559-325-3503
Practice Address - Fax:559-325-3504
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT2716225X00000X
225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOT2716OtherCA BD OF OCCUPATIONAL THERAPY