Healthcare Provider Details

I. General information

NPI: 1134601834
Provider Name (Legal Business Name): ANGEL MARIO OLVERA OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2018
Last Update Date: 08/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S 12TH ST
MCALLEN TX
78501-5037
US

IV. Provider business mailing address

7012 BUENA VISTA DR
PALMVIEW TX
78572-1873
US

V. Phone/Fax

Practice location:
  • Phone: 956-682-4171
  • Fax:
Mailing address:
  • Phone: 956-467-8822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number116826
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: