Healthcare Provider Details

I. General information

NPI: 1174653851
Provider Name (Legal Business Name): OCC MED ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 BRIERCROFT OFFICE PARK
LUBBOCK TX
79412-3011
US

IV. Provider business mailing address

25 BRIERCROFT OFFICE PARK
LUBBOCK TX
79412-3011
US

V. Phone/Fax

Practice location:
  • Phone: 806-795-7433
  • Fax: 806-795-7407
Mailing address:
  • Phone: 806-795-7433
  • Fax: 806-795-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberL9072
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberF3836
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberG2800
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number654240000
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number555410000
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberE6784
License Number StateTX

VIII. Authorized Official

Name: BRYCE HARVEY OLSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 806-795-7433