Provider Demographics
NPI:1982358420
Name:BLUEBONNET PEDIATRIC THERAPY
Entity Type:Organization
Organization Name:BLUEBONNET PEDIATRIC THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:817-800-4431
Mailing Address - Street 1:122 N STAR CT
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-7830
Mailing Address - Country:US
Mailing Address - Phone:817-800-4431
Mailing Address - Fax:
Practice Address - Street 1:18 SCENIC LOOP RD # 200D
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8672
Practice Address - Country:US
Practice Address - Phone:817-800-4431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457606469OtherNPI