Provider Demographics
NPI:1861632747
Name:GUEVARA, MIRIAN (OTR)
Entity Type:Individual
Prefix:MRS
First Name:MIRIAN
Middle Name:
Last Name:GUEVARA
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 1:4423 SHADOWDALE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77041-8718
Mailing Address - Country:US
Mailing Address - Phone:713-466-6872
Mailing Address - Fax:713-466-9547
Practice Address - Street 1:4423 SHADOWDALE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77041-8718
Practice Address - Country:US
Practice Address - Phone:713-466-6872
Practice Address - Fax:713-466-9547
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112746225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist