Individual provider Active NPI

Mirian Guevara, OTR

  • Occupational Therapist
  • Houston, TX
National Provider Identifier
1861632747
Registry record updated Feb 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
112746 Issued in TX
Practice address
4423 Shadowdale Dr
Houston, TX 77041-8718
Phone
(713) 466-6872
Fax
(713) 466-9547
NPI assigned
Mar 4, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 112746 TX Primary

Addresses

Primary practice location

4423 Shadowdale Dr
Houston, TX 77041-8718

Mailing address

4423 Shadowdale Dr
Houston, TX 77041-8718
Phone (713) 466-6872

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210415001939 TX Practitioner - Occupational Therapist in Private Practice 9436567237 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
112746TXMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Speech Services L.L.C. CurrentSince Mar 1, 2021 Accepting new patients
Legacy Speech Services L.L.C. Past Accepting new patients

Locations

2026 Wirt Rd
Ste 103B
Houston, TX 77055
Phone (832) 980-7061

633 E Fernhurst Dr
Ste 604
Katy, TX 77450
Phone (832) 980-7061

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1236124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1297382400000",
    "number": "1861632747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4423 SHADOWDALE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770418718",
            "telephone_number": "713-466-6872",
            "fax_number": "713-466-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4423 SHADOWDALE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770418718",
            "telephone_number": "713-466-6872",
            "fax_number": "713-466-9547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUEVARA",
        "first_name": "MIRIAN",
        "name_prefix": "Mrs.",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-04",
        "last_updated": "2011-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TX",
            "license": "112746",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.