Provider Demographics
NPI:1104834852
Name:OLIVAREZ, KIMBERLY TREVINO (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:TREVINO
Last Name:OLIVAREZ
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6020 N 29TH LANE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-631-6896
Mailing Address - Fax:956-618-2439
Practice Address - Street 1:2109 SOUTH K CENTER STREET
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-688-5515
Practice Address - Fax:956-686-9277
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QR0400X224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant