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General NPI Number Information
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NPI Number | 1790811297
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Entity Type | Organization
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Legal Business Name | THERATEAM REHAB, LLC
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 909 HEMLOCK TRL
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City | SAGINAW
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State | TX
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Zip | 76131-3551
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Country | US
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Telephone | 817-455-1614
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Fax |
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Provider Business Mailing Address
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Address Line | 909 HEMLOCK TRL
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City | SAGINAW
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State | TX
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Zip | 76131-3551
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Country | US
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Telephone | 817-455-1614
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | MARY M HOLSTEIN
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Credential | L.O.T.
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Telephone | 817-455-1614
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 104978
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License Number State | TX
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