Individual
MIRTA GUAJARDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
3210 LOOP 20 STE. 5, LAREDO, TX 78043
(956) 712-9111
Mailing address
3210 LOOP 20 STE. 5, LAREDO, TX 78043
(956) 712-9111
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
208668
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171436201
—
TX
Enumeration date
02/06/2013
Last updated
08/16/2018
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