Provider Demographics
NPI:1184105744
Name:PIMM, BERTHA MAY (COTA)
Entity type:Individual
Prefix:
First Name:BERTHA
Middle Name:MAY
Last Name:PIMM
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 ROLLING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:HARPER
Mailing Address - State:TX
Mailing Address - Zip Code:78631-8615
Mailing Address - Country:US
Mailing Address - Phone:830-864-5447
Mailing Address - Fax:
Practice Address - Street 1:210 W WINDCREST ST
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-4408
Practice Address - Country:US
Practice Address - Phone:830-637-7885
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210337224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty