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General NPI Number Information
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NPI Number | 1194671909
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Entity Type | Organization
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Legal Business Name | BESPOKE ADAPTIVE LIFE
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Dates
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Enumeration Date | 03/05/2026
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Last Update Date | 03/05/2026
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Provider Practice Location Address
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Address Line | 5300 RANCH POINT DR STE C
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City | KATY
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State | TX
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Zip | 77494-7355
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Country | US
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Telephone | 346-880-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 5300 RANCH POINT DR STE D
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City | KATY
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State | TX
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Zip | 77494-7355
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Country | US
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Telephone | 346-880-8002
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | TIFFANY OKORO
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Credential |
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Telephone | 346-880-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 372500000X
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Taxonomy Name | Chore Provider
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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