Healthcare Provider Details

I. General information

NPI: 1134801525
Provider Name (Legal Business Name): JATAVIA BUGGS OTD, OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4055 TECHNOLOGY FOREST BLVD
SPRING TX
77381-2007
US

IV. Provider business mailing address

4055 TECHNOLOGY FOREST BLVD STE 100
SPRING TX
77381-2008
US

V. Phone/Fax

Practice location:
  • Phone: 832-463-2480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number123795
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: