Provider Demographics
NPI:1013394873
Name:ADAPTIVE MODIFICATIONS LLC
Entity Type:Organization
Organization Name:ADAPTIVE MODIFICATIONS LLC
Other - Org Name:ADAPTIVE MODIFICATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OCCUPATIONAL THERAPY CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BOREN
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:972-754-7103
Mailing Address - Street 1:6710 VIRGINIA PKWY
Mailing Address - Street 2:STE 215-70
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-5514
Mailing Address - Country:US
Mailing Address - Phone:972-754-7103
Mailing Address - Fax:214-592-0860
Practice Address - Street 1:6710 VIRGINIA PKWY
Practice Address - Street 2:STE 215-70
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5514
Practice Address - Country:US
Practice Address - Phone:972-754-7103
Practice Address - Fax:214-592-0860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies