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General NPI Number Information
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NPI Number | 1619940012
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Entity Type | Organization
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Legal Business Name | OPTIMUM KIDS LTD
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 02/05/2021
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Provider Practice Location Address
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Address Line | 508 W GRIFFIN PKWY SUITE A
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City | MISSION
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State | TX
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Zip | 78572-2223
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Country | US
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Telephone | 956-583-1527
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Fax |
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Provider Business Mailing Address
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Address Line | 508 W GRIFFIN PKWY SUITE A
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City | MISSION
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State | TX
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Zip | 78572-2223
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Country | US
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Telephone | 956-583-1527
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAURICE L MCDONALD
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Credential | DPT
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Telephone | 956-583-1527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 550830000
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QR0401X
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Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
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License Number | 650620000
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 261QR0400X
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Taxonomy Name | Rehabilitation Clinic/Center
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License Number |
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License Number State |
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