Provider Demographics
NPI:1124371562
Name:LITTLE SPROUTS REHABILITATION
Entity Type:Organization
Organization Name:LITTLE SPROUTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER, OTR
Authorized Official - Prefix:
Authorized Official - First Name:CRISELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-292-1780
Mailing Address - Street 1:1014 LOST MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:DONNA
Mailing Address - State:TX
Mailing Address - Zip Code:78537-9536
Mailing Address - Country:US
Mailing Address - Phone:956-292-1780
Mailing Address - Fax:
Practice Address - Street 1:5753 N FM 493
Practice Address - Street 2:
Practice Address - City:DONNA
Practice Address - State:TX
Practice Address - Zip Code:78537-5185
Practice Address - Country:US
Practice Address - Phone:956-464-4786
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty