Provider Demographics
NPI:1831268135
Name:WIGGLES CHILDREN'S REHAB
Entity type:Organization
Organization Name:WIGGLES CHILDREN'S REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAYAVEDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC SLP
Authorized Official - Phone:956-585-2439
Mailing Address - Street 1:2011 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3222
Mailing Address - Country:US
Mailing Address - Phone:956-585-2439
Mailing Address - Fax:956-585-3145
Practice Address - Street 1:2011 E GRIFFIN PKWY
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3222
Practice Address - Country:US
Practice Address - Phone:956-585-2439
Practice Address - Fax:956-585-3145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18814305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization