Provider Demographics
NPI:1891990354
Name:SERENA SPEAKER OTR PC
Entity Type:Organization
Organization Name:SERENA SPEAKER OTR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERENA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SPEAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-251-7389
Mailing Address - Street 1:8273 PARKISONS LN
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-1924
Mailing Address - Country:US
Mailing Address - Phone:979-251-7389
Mailing Address - Fax:979-251-7389
Practice Address - Street 1:8273 PARKISONS LN
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-1924
Practice Address - Country:US
Practice Address - Phone:979-251-7389
Practice Address - Fax:979-251-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00X623Medicare PIN