Provider Demographics
NPI:1235507104
Name:GUERRERO, MIRIAM GUADALUPE (OTR)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:GUADALUPE
Last Name:GUERRERO
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 1:905 E LOS EBANOS BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-8720
Mailing Address - Country:US
Mailing Address - Phone:956-455-1869
Mailing Address - Fax:956-455-2569
Practice Address - Street 1:905 E LOS EBANOS BLVD STE C
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-8720
Practice Address - Country:US
Practice Address - Phone:956-455-1869
Practice Address - Fax:956-544-2569
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116123225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist