Provider Demographics
NPI:1639782170
Name:SIDERS, JULIANA TARINNE (OTR)
Entity Type:Individual
Prefix:
First Name:JULIANA
Middle Name:TARINNE
Last Name:SIDERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:JULIANA
Other - Middle Name:TARINNE
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 ARTESIAN WAY
Mailing Address - Street 2:
Mailing Address - City:ROMAN FOREST
Mailing Address - State:TX
Mailing Address - Zip Code:77357-3004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17045 EL CAMINO REAL STE 106
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2623
Practice Address - Country:US
Practice Address - Phone:281-480-5648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121078225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist