Provider Demographics
NPI:1881709178
Name:BOURIANOFF, BJORG TUPPEN (OT)
Entity type:Individual
Prefix:
First Name:BJORG
Middle Name:TUPPEN
Last Name:BOURIANOFF
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3762 DRUMMOND ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-2418
Mailing Address - Country:US
Mailing Address - Phone:713-622-0598
Mailing Address - Fax:
Practice Address - Street 1:2158 PORTSMOUTH ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4057
Practice Address - Country:US
Practice Address - Phone:713-529-4990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100227225XH1200X
TX1012532225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100227OtherLICENSE #