Breana Gervacio

Primary specialty

Pediatric Occupational TherapistTaxonomy code 225XP0200X

License

117892 Issued in TX

Practice address

2335 E Saunders St # 3
Laredo, TX 78041-5434

Phone

(956) 717-0441

NPI assigned

Sep 21, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1474416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708905600000",
    "number": "1174071930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N 85TH ST UNIT 127",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981033818",
            "telephone_number": "956-337-6606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2335 E SAUNDERS ST # 3",
            "city": "LAREDO",
            "state": "TX",
            "postal_code": "780415434",
            "telephone_number": "956-717-0441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERVACIO",
        "first_name": "BREANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-21",
        "last_updated": "2024-02-26",
        "certification_date": "2024-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "WA",
            "license": "61513765",
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "TX",
            "license": "117892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genoa Healthcare LLC
• Gentle Heart Counseling & Supervision, PLLC
• George H. Garcia, D.D.S., PLLC
• Gerardo Ramos MD PA
• Dafna Leah Gerber, LCSW
• Mohsen Ghadimi-Mahani, M.D.
• Alina Ghani, M.D.
• Khalid A Ghazy, MD
• Gibson Chiropractic, PLLC
• David Layne Gibson, DC

• Pediatric Occupational Therapist in Laredo, TX
• Providers in Laredo, TX by specialty
• Pediatric Occupational Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.