Provider Demographics
NPI:1518365808
Name:MIRES, KATHLEEN (OT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MIRES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:NEEDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77461-7378
Mailing Address - Country:US
Mailing Address - Phone:713-553-7772
Mailing Address - Fax:
Practice Address - Street 1:7040 BAKER RD
Practice Address - Street 2:
Practice Address - City:NEEDVILLE
Practice Address - State:TX
Practice Address - Zip Code:77461-7378
Practice Address - Country:US
Practice Address - Phone:713-553-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106136225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist