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General NPI Number Information
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NPI Number | 1053683177
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Entity Type | Organization
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Legal Business Name | BLAST-OFF THERAPY CENTER, PLLC
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Dates
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Enumeration Date | 02/05/2012
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Last Update Date | 02/05/2012
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Provider Practice Location Address
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Address Line | 38615 MILE 7 RD UNIT 4
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City | PENITAS
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State | TX
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Zip | 78576-8474
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Country | US
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Telephone | 956-583-0279
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Fax | 956-583-0706
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Provider Business Mailing Address
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Address Line | 38615 MILE 7 RD UNIT 4
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City | PENITAS
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State | TX
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Zip | 78576-8474
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Country | US
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Telephone | 956-583-0279
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Fax | 956-583-0706
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | BELINDA RAMIREZ
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Credential |
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Telephone | 956-583-0279
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 112204
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License Number State | TX
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