Provider Demographics
NPI:1558838425
Name:BAUTISTA, ADAM JAMES (OTR)
Entity Type:Individual
Prefix:
First Name:ADAM JAMES
Middle Name:
Last Name:BAUTISTA
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 1:411 N WASHINGTON AVE STE 3900
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1713
Mailing Address - Country:US
Mailing Address - Phone:945-468-9009
Mailing Address - Fax:945-468-3044
Practice Address - Street 1:411 N WASHINGTON AVE STE 3900
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1713
Practice Address - Country:US
Practice Address - Phone:945-468-9009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-30
Last Update Date:2023-11-20
Deactivation Date:2023-03-14
Deactivation Code:
Reactivation Date:2023-04-25
Provider Licenses
StateLicense IDTaxonomies
TX123410225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist