Provider Demographics
NPI:1639205644
Name:MOULTON ISD
Entity Type:Organization
Organization Name:MOULTON ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUKSOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-596-4609
Mailing Address - Street 1:PO BOX C
Mailing Address - Street 2:400 BOBKAT DR
Mailing Address - City:MOULTON
Mailing Address - State:TX
Mailing Address - Zip Code:77975-0070
Mailing Address - Country:US
Mailing Address - Phone:361-596-4609
Mailing Address - Fax:361-596-7578
Practice Address - Street 1:400 BOBKAT DR
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:TX
Practice Address - Zip Code:77975
Practice Address - Country:US
Practice Address - Phone:361-596-4609
Practice Address - Fax:361-596-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
No164X00000XNursing Service ProvidersLicensed Vocational NurseGroup - Multi-Specialty
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty