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General NPI Number Information
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NPI Number | 1295526416
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Entity Type | Organization
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Legal Business Name | BESPOKE THERAPY LLC
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Dates
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Enumeration Date | 05/15/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 19602 AVENTINE PLANTATION DR
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City | KATY
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State | TX
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Zip | 77449-2689
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Country | US
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Telephone | 832-490-0210
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Fax | 713-489-4056
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Provider Business Mailing Address
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Address Line | 19602 AVENTINE PLANTATION DR
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City | KATY
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State | TX
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Zip | 77449-2689
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Country | US
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Telephone | 832-490-0210
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MIRELYS D ARCI BENCOMO
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Credential |
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Telephone | 832-490-0210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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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 | 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 #4
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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