Provider Demographics
NPI:1912580515
Name:MOTIV8 PEDIATRIC THERAPY, LLC
Entity Type:Organization
Organization Name:MOTIV8 PEDIATRIC THERAPY, LLC
Other - Org Name:MOTIV8 PEDIATRIC THERAPY, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OTR, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NAHIR
Authorized Official - Last Name:PADILLA MELENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, OTD
Authorized Official - Phone:409-998-0388
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:LEAGUE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77574-0591
Mailing Address - Country:US
Mailing Address - Phone:409-998-0388
Mailing Address - Fax:409-299-3131
Practice Address - Street 1:6226 WATFORD DR
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-7152
Practice Address - Country:US
Practice Address - Phone:409-998-0388
Practice Address - Fax:409-299-3131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-30
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1902317183Medicaid