Provider Demographics
NPI:1427399799
Name:LIAMIS GOMEZ, CALLIOPE
Entity Type:Individual
Prefix:MISS
First Name:CALLIOPE
Middle Name:
Last Name:LIAMIS GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 S BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-4753
Mailing Address - Country:US
Mailing Address - Phone:512-827-3601
Mailing Address - Fax:
Practice Address - Street 1:2423 S BELL BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-4753
Practice Address - Country:US
Practice Address - Phone:512-827-3601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115329225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115329OtherOCCUPATIONAL THERAPY LICENSE