Provider Demographics
NPI:1346359601
Name:KATZAKIS, SPIROS (OTR)
Entity Type:Individual
Prefix:MR
First Name:SPIROS
Middle Name:
Last Name:KATZAKIS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 309
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-0309
Mailing Address - Country:US
Mailing Address - Phone:956-440-7783
Mailing Address - Fax:956-440-8341
Practice Address - Street 1:721 W TYLER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6155
Practice Address - Country:US
Practice Address - Phone:956-440-7783
Practice Address - Fax:956-440-8341
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106282225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82920TOtherBLUE CROSS BLUE SHIELD
TX8T1966OtherBLUE CROSS/BLUE SHIELD
TX106282OtherOTR LICENCE
TX999147OtherNATIONAL BOARD OTR