Provider Demographics
NPI:1932272283
Name:STARK, JASON LYNN (OTR)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:LYNN
Last Name:STARK
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77009-7100
Mailing Address - Country:US
Mailing Address - Phone:713-397-2708
Mailing Address - Fax:281-655-0762
Practice Address - Street 1:16835 DEER CREEK DR STE 120
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-5803
Practice Address - Country:US
Practice Address - Phone:281-379-4373
Practice Address - Fax:713-655-0762
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109631225X00000X, 225XN1300X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XN1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistNeurorehabilitation