Provider Demographics
NPI:1306467220
Name:GUANGKO, JANINE GOLEZ (OTR/L)
Entity type:Individual
Prefix:
First Name:JANINE
Middle Name:GOLEZ
Last Name:GUANGKO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7709 VAL VERDE DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7454
Mailing Address - Country:US
Mailing Address - Phone:469-584-1663
Mailing Address - Fax:
Practice Address - Street 1:6200 VIRGINIA PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5504
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112358225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist