Provider Demographics
NPI:1134601834
Name:OLVERA, ANGEL MARIO (OTR)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:MARIO
Last Name:OLVERA
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 1:7012 BUENA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-1873
Mailing Address - Country:US
Mailing Address - Phone:956-467-8822
Mailing Address - Fax:
Practice Address - Street 1:900 S 12TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-5037
Practice Address - Country:US
Practice Address - Phone:956-682-4171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116826225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty