Provider Demographics
NPI:1578910873
Name:UPGRADE OCCUPATIONAL THERAPY
Entity Type:Organization
Organization Name:UPGRADE OCCUPATIONAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR
Authorized Official - Prefix:
Authorized Official - First Name:HARMONY
Authorized Official - Middle Name:KARINA
Authorized Official - Last Name:STANDARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-238-5103
Mailing Address - Street 1:PO BOX 642
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-0642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19007 SCENIC LOOP RD
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-9206
Practice Address - Country:US
Practice Address - Phone:210-238-5103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty