Provider Demographics
NPI:1477875656
Name:PEDIATRIC ACTION THERAPY, LLC
Entity Type:Organization
Organization Name:PEDIATRIC ACTION THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARCELA
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MOT, OTR, BCBA, C/ND
Authorized Official - Phone:954-540-1360
Mailing Address - Street 1:12 DER FLUGPLATZ
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8661
Mailing Address - Country:US
Mailing Address - Phone:954-540-1360
Mailing Address - Fax:830-755-6525
Practice Address - Street 1:12 DER FLUGPLATZ
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8661
Practice Address - Country:US
Practice Address - Phone:954-540-1360
Practice Address - Fax:830-755-6525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1096577103K00000X
TX111734225XP0200X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty