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General NPI Number Information
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NPI Number | 1598163511
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Entity Type | Individual
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Provider Name | STACI TIBBS WILSON OTR, MOT, CHES
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Gender | Female
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Dates
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Enumeration Date | 12/08/2014
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 13212 LONE CREEK LN
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City | PEARLAND
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State | TX
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Zip | 77584-3476
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Country | US
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Telephone | 713-280-3663
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Fax | 855-710-7269
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Provider Business Mailing Address
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Address Line | 11601 SHADOW CREEK PKWY STE 111-216
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City | PEARLAND
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State | TX
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Zip | 77584-7283
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Country | US
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Telephone | 713-280-3663
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Fax | 855-710-7269
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XG0600X
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Taxonomy Name | Gerontology Occupational 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 | 225XN1300X
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Taxonomy Name | Neurorehabilitation Occupational Therapist
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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 | 225XL0004X
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Taxonomy Name | Low Vision Occupational Therapist
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License Number | 112297
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License Number State | TX
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