Healthcare Provider Details

I. General information

NPI: 1174890834
Provider Name (Legal Business Name): ROLANDO CUELLAR OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

864 CENTRAL BLVD STE 3200
BROWNSVILLE TX
78520-8282
US

IV. Provider business mailing address

864 CENTRAL BLVD STE 3200
BROWNSVILLE TX
78520-8282
US

V. Phone/Fax

Practice location:
  • Phone: 956-280-5491
  • Fax:
Mailing address:
  • Phone: 956-280-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number211315
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number121154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: