Provider Demographics
NPI:1104521244
Name:GUTIERREZ, SANDRA NOE (OTR)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:NOE
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 1:2101 GREENLEE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3941
Mailing Address - Country:US
Mailing Address - Phone:915-241-0995
Mailing Address - Fax:
Practice Address - Street 1:12440 ROJAS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928-5261
Practice Address - Country:US
Practice Address - Phone:915-937-1896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-30
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109140251300000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No251300000XAgenciesLocal Education Agency (LEA)