Provider Demographics
NPI:1720397318
Name:GUAJARDO, LAURA TAMAYO (OTR)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:TAMAYO
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:CARRASCO
Other - Last Name:TAMAYO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2203 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4412
Mailing Address - Country:US
Mailing Address - Phone:210-614-3911
Mailing Address - Fax:210-616-0443
Practice Address - Street 1:2203 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-614-3911
Practice Address - Fax:210-616-0443
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113674225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist