Healthcare Provider Details

I. General information

NPI: 1780204420
Provider Name (Legal Business Name): OCCUPATIONAL ADVANTAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2020
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 MAIN ST STE 903
KATY TX
77494-0109
US

IV. Provider business mailing address

1325 MAIN ST STE 903
KATY TX
77494-0109
US

V. Phone/Fax

Practice location:
  • Phone: 832-680-3561
  • Fax:
Mailing address:
  • Phone: 832-680-3561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DIONISE HEREDIA-THOMAS
Title or Position: OWNER/MEMBER
Credential: OTR
Phone: 361-537-8463