Healthcare Provider Details

I. General information

NPI: 1932272283
Provider Name (Legal Business Name): JASON LYNN STARK OTR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16835 DEER CREEK DR STE 120
SPRING TX
77379-5803
US

IV. Provider business mailing address

1022 EUCLID ST
HOUSTON TX
77009-7100
US

V. Phone/Fax

Practice location:
  • Phone: 281-379-4373
  • Fax: 713-655-0762
Mailing address:
  • Phone: 713-397-2708
  • Fax: 281-655-0762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number109631
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225XN1300X
TaxonomyNeurorehabilitation Occupational Therapist
License Number109631
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number109631
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: