Provider Demographics
NPI:1548699929
Name:GUTIERREZ, TANIA (OTR)
Entity type:Individual
Prefix:MS
First Name:TANIA
Middle Name:
Last Name:GUTIERREZ
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 1:5412 BRAND ST
Mailing Address - Street 2:BLDG. C-3
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-9463
Mailing Address - Country:US
Mailing Address - Phone:956-488-1818
Mailing Address - Fax:956-488-1819
Practice Address - Street 1:5412 BRAND ST
Practice Address - Street 2:BLDG. C-3
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-9463
Practice Address - Country:US
Practice Address - Phone:956-488-1818
Practice Address - Fax:956-488-1819
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115739225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist