Provider Demographics
NPI:1609430594
Name:GUERRA, KIMBERLY (COTA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GUERRA
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E FERGUSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-2667
Mailing Address - Country:US
Mailing Address - Phone:956-961-4755
Mailing Address - Fax:956-961-4764
Practice Address - Street 1:600 E FERGUSON ST STE A
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-2667
Practice Address - Country:US
Practice Address - Phone:956-961-4755
Practice Address - Fax:956-961-4764
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX215633224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant