Provider Demographics
NPI:1881983732
Name:GUEVARA, LIZETT M (OTR)
Entity type:Individual
Prefix:
First Name:LIZETT
Middle Name:M
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 1:1305 PECAN AVE
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2002 N CONWAY AVE
Practice Address - Street 2:SUITE F
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-2902
Practice Address - Country:US
Practice Address - Phone:956-580-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113869225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX149229001Medicaid