Provider Demographics
NPI:1700366804
Name:BARRERA, EDIEL IVAN (OTR)
Entity Type:Individual
Prefix:
First Name:EDIEL
Middle Name:IVAN
Last Name:BARRERA
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3912 LORI MORGAN DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4853
Mailing Address - Country:US
Mailing Address - Phone:956-500-3841
Mailing Address - Fax:
Practice Address - Street 1:2109 S K ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5689
Practice Address - Country:US
Practice Address - Phone:956-686-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116864225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist