Provider Demographics
NPI:1073088688
Name:DISTINCT ABILITIES ACADEMIC PROGRAM
Entity Type:Organization
Organization Name:DISTINCT ABILITIES ACADEMIC PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:CONNATSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-585-5140
Mailing Address - Street 1:851 N DILLING ST
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-5675
Mailing Address - Country:US
Mailing Address - Phone:281-585-5140
Mailing Address - Fax:
Practice Address - Street 1:851 N DILLING ST
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5675
Practice Address - Country:US
Practice Address - Phone:281-585-5140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty