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General NPI Number Information
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NPI Number | 1831845254
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Entity Type | Organization
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Legal Business Name | DISTINCT ABILITIES CHILDREN'S THERAPY, LLCP
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Dates
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Enumeration Date | 02/24/2022
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Last Update Date | 02/24/2022
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Provider Practice Location Address
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Address Line | 203 BLOSSOM ST
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-488-0436
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Fax | 281-488-0102
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Provider Business Mailing Address
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Address Line | 203 BLOSSOM ST
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City | WEBSTER
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State | TX
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Zip | 77598
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Country | US
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Telephone | 281-488-0436
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Fax | 281-488-0102
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. CINDY MAZZOLA
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Credential | COTA
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Telephone | 281-488-0436
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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 |
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License Number State |
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