MEDICARE: LARA GIMENEZ ENARIO OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	OTR1897	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730391038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARA GIMENEZ ENARIO OTR

Provider Business Mailing Address
First Line	:	5665 CREEKSIDE FOREST DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77389-4969
Country	:	US
Telephone Number	:	281-255-8180
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 CREEKSIDE FOREST DR
Second Line	:
City	:	THE WOODLANDS
State	:	TX
Zip	:	77389
Country	:	US
Telephone Number	:	281-255-8180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/10/2018

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