MEDICARE: MIGHTY OAKS THERAPIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist

General Provider Information

NPI Number	:	1790330827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIGHTY OAKS THERAPIES

Provider Business Mailing Address
First Line	:	11403 BARKER CYPRESS RD
Second Line	:	STE J, #105
City	:	CYPRESS
State	:	TX
Zip	:	77433
Country	:	US
Telephone Number	:	512-669-1503
Fax Number	:

Provider Business Practice Location Address
First Line	:	18100 WEST RD APT 1216
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77095-3785
Country	:	US
Telephone Number	:	512-669-1503
Fax Number	:

Authorized Official
Title or Position	:	OTR
Name	:	STACY ELAINE COOK
Credential	:	OTR
Telephone Number	:	832-792-9399

Provider Enumeration Date	:	08/06/2019
Last Update Date	:	08/06/2019

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Directions to “MIGHTY OAKS THERAPIES ” Practice Location

Language	Start Address	Practice Location

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