Basic Information
| Provider Information | |||||||||
| NPI: | 1306467220 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUANGKO | ||||||||
| FirstName: | JANINE | ||||||||
| MiddleName: | GOLEZ | ||||||||
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| Credential: | OTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7709 VAL VERDE DR | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750717454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4695841663 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6200 VIRGINIA PKWY | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750715504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724240148 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2020 | ||||||||
| LastUpdateDate: | 05/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 112358 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.