=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881012920
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REACH, ENJOY ACTIVITIES FOR LIFE, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2014
-----------------------------------------------------
Last Update Date | 04/05/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1505 WOODHEAD ST APT 3
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-655-2894
-----------------------------------------------------
Fax | 713-485-4862
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1505 WOODHEAD ST APT 3
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77019-5338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 832-655-2894
-----------------------------------------------------
Fax | 713-485-4862
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, OCCUPATIONAL THERAPIST
-----------------------------------------------------
Name | MRS. JOANNE BOOKER CRANE
-----------------------------------------------------
Credential | OTR
-----------------------------------------------------
Telephone | 832-655-2894
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225XP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Occupational Therapist
-----------------------------------------------------
License Number | 113644
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------