Provider Demographics
NPI:1811417769
Name:TEXAS CHAMPION PEDIATRIC REHAB, LLC
Entity Type:Organization
Organization Name:TEXAS CHAMPION PEDIATRIC REHAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, MOT
Authorized Official - Phone:210-858-5006
Mailing Address - Street 1:9907 COCHEM PATH
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4616
Mailing Address - Country:US
Mailing Address - Phone:210-274-2959
Mailing Address - Fax:
Practice Address - Street 1:9907 COCHEM PATH
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4616
Practice Address - Country:US
Practice Address - Phone:210-274-2959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114265225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty