Provider Demographics
NPI:1952978785
Name:GUTIERREZ, RAVEN (OTR/L)
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8905 OCEAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4421
Mailing Address - Country:US
Mailing Address - Phone:228-215-0521
Mailing Address - Fax:228-215-0619
Practice Address - Street 1:8905 OCEAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4421
Practice Address - Country:US
Practice Address - Phone:228-215-0521
Practice Address - Fax:228-215-0619
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-09
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSOT3848225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist