Provider Demographics
NPI:1427640226
Name:GAMEZ, LAURA GENESYS
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:GENESYS
Last Name:GAMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:982 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3422
Mailing Address - Country:US
Mailing Address - Phone:956-960-5525
Mailing Address - Fax:
Practice Address - Street 1:801 E FERN AVE STE 103
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1523
Practice Address - Country:US
Practice Address - Phone:956-627-0902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216516224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX216516OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS