Provider Demographics
NPI:1831845254
Name:DISTINCT ABILITIES CHILDREN'S THERAPY, LLCP
Entity type:Organization
Organization Name:DISTINCT ABILITIES CHILDREN'S THERAPY, LLCP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOLA
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:281-488-0436
Mailing Address - Street 1:203 BLOSSOM ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598
Mailing Address - Country:US
Mailing Address - Phone:281-488-0436
Mailing Address - Fax:281-488-0102
Practice Address - Street 1:203 BLOSSOM ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598
Practice Address - Country:US
Practice Address - Phone:281-488-0436
Practice Address - Fax:281-488-0102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty