Provider Demographics
NPI:1366895609
Name:GUTIERREZ TRIVENO, LISBETH GISELLE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:LISBETH
Middle Name:GISELLE
Last Name:GUTIERREZ TRIVENO
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:LISBETH
Other - Middle Name:GISELLE
Other - Last Name:TRIVENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6343 VIA DE SONRISA DEL SUR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-8211
Mailing Address - Country:US
Mailing Address - Phone:561-392-5940
Mailing Address - Fax:
Practice Address - Street 1:6343 VIA DE SONRISA DEL SUR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-8211
Practice Address - Country:US
Practice Address - Phone:561-392-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17939225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist