Provider Demographics
NPI:1073226841
Name:PUR OCCUPATIONAL THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:PUR OCCUPATIONAL THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAVARRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:504-300-7425
Mailing Address - Street 1:9939 FREDERICKSBURG RD APT 1815
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4158
Mailing Address - Country:US
Mailing Address - Phone:726-336-1818
Mailing Address - Fax:
Practice Address - Street 1:9939 FREDERICKSBURG RD APT 1815
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4158
Practice Address - Country:US
Practice Address - Phone:726-336-1818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM1000XAmbulatory Health Care FacilitiesClinic/CenterMigrant Health
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine