Provider Demographics
NPI:1659559896
Name:GUTIERREZ, MARTHA LAURA (COTA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:LAURA
Last Name:GUTIERREZ
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 1:302 LILLY DR
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:TX
Mailing Address - Zip Code:78589-4927
Mailing Address - Country:US
Mailing Address - Phone:956-457-8691
Mailing Address - Fax:
Practice Address - Street 1:302 LILLY DR
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-4927
Practice Address - Country:US
Practice Address - Phone:956-457-8691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX209568224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant