Provider Demographics
NPI:1497826945
Name:INNOVATIVE OCCUPATIONAL THERAPY SERVICES, PC
Entity Type:Organization
Organization Name:INNOVATIVE OCCUPATIONAL THERAPY SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-765-1277
Mailing Address - Street 1:PO BOX 14892
Mailing Address - Street 2:
Mailing Address - City:ZAPATA
Mailing Address - State:TX
Mailing Address - Zip Code:78076-4892
Mailing Address - Country:US
Mailing Address - Phone:956-765-1277
Mailing Address - Fax:956-765-5339
Practice Address - Street 1:2113 N. HWY 83
Practice Address - Street 2:
Practice Address - City:ZAPATA
Practice Address - State:TX
Practice Address - Zip Code:78076
Practice Address - Country:US
Practice Address - Phone:956-765-1277
Practice Address - Fax:956-765-5339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105936225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00493EOtherBCBS GROUP PROVIDER #
TX080687901Medicaid
TX00493EMedicare PIN