Basic Information
| Provider Information | |||||||||
| NPI: | 1730391038 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ENARIO | ||||||||
| FirstName: | LARA | ||||||||
| MiddleName: | GIMENEZ | ||||||||
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| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5665 CREEKSIDE FOREST DR | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773894969 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812558180 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5665 CREEKSIDE FOREST DR | ||||||||
| Address2: | |||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812558180 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 08/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | OTR1897 | AR | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 162457721 | 05 | AR | MEDICAID |