Healthcare Provider Details

I. General information

NPI: 1548222052
Provider Name (Legal Business Name): BIANCA CHRISTINE GEORGAKAKIS OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 INTERNET BLVD SUITE # 107
FRISCO TX
75034-9085
US

IV. Provider business mailing address

5625 OVERLAND DR
THE COLONY TX
75056-3763
US

V. Phone/Fax

Practice location:
  • Phone: 972-377-7289
  • Fax:
Mailing address:
  • Phone: 214-952-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number111596
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: