Provider Demographics
NPI:1609107002
Name:GERALDEZ, MARIA CARINA (OTR)
Entity Type:Individual
Prefix:
First Name:MARIA CARINA
Middle Name:
Last Name:GERALDEZ
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 1:3501 N MACARTHUR BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3660
Mailing Address - Country:US
Mailing Address - Phone:214-260-3197
Mailing Address - Fax:
Practice Address - Street 1:3501 N MACARTHUR BLVD STE 650
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3660
Practice Address - Country:US
Practice Address - Phone:214-260-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-25
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX304891225X00000X
TX113605225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149984001Medicaid
TX149984001Medicaid
TX676535Medicare PIN