Provider Demographics
NPI:1760892913
Name:POLKADOT PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:POLKADOT PEDIATRIC THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PLOETNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-752-8739
Mailing Address - Street 1:800 WILCREST DR
Mailing Address - Street 2:SUITE 175
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-6301
Mailing Address - Country:US
Mailing Address - Phone:832-752-8739
Mailing Address - Fax:281-652-5521
Practice Address - Street 1:800 WILCREST DR
Practice Address - Street 2:SUITE 175
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-6301
Practice Address - Country:US
Practice Address - Phone:832-752-8739
Practice Address - Fax:281-652-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110282225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty