Provider Demographics
NPI:1770931891
Name:BASS, ERIC (OT)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:BASS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 EAGLE BLVD
Mailing Address - Street 2:
Mailing Address - City:FRITCH
Mailing Address - State:TX
Mailing Address - Zip Code:79036-8150
Mailing Address - Country:US
Mailing Address - Phone:806-433-0212
Mailing Address - Fax:
Practice Address - Street 1:1100 S COULTER ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1836
Practice Address - Country:US
Practice Address - Phone:806-468-9700
Practice Address - Fax:806-468-9771
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117364225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist