Provider Demographics
NPI:1790330827
Name:MIGHTY OAKS THERAPIES
Entity Type:Organization
Organization Name:MIGHTY OAKS THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OTR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:832-792-9399
Mailing Address - Street 1:11403 BARKER CYPRESS RD
Mailing Address - Street 2:STE J, #105
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433
Mailing Address - Country:US
Mailing Address - Phone:512-669-1503
Mailing Address - Fax:
Practice Address - Street 1:18100 WEST RD APT 1216
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-3785
Practice Address - Country:US
Practice Address - Phone:512-669-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty