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General NPI Number Information
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NPI Number | 1760892913
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Entity Type | Organization
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Legal Business Name | POLKADOT PEDIATRIC THERAPY, LLC
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Dates
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Enumeration Date | 04/28/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 800 WILCREST DR SUITE 175
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City | HOUSTON
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State | TX
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Zip | 77042-6301
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Country | US
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Telephone | 832-752-8739
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Fax | 281-652-5521
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Provider Business Mailing Address
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Address Line | 800 WILCREST DR SUITE 175
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City | HOUSTON
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State | TX
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Zip | 77042-6301
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Country | US
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Telephone | 832-752-8739
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Fax | 281-652-5521
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Authorized Official
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Title or Position | OWNER
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Name | JULIE PLOETNER
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Credential |
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Telephone | 832-752-8739
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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 | 110282
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License Number State | TX
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