=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881415024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OCCUPATIONAL HEALTHCARE PLUS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2024
-----------------------------------------------------
Last Update Date | 10/21/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1001 W BAKER RD STE 100
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-2385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-427-6525
-----------------------------------------------------
Fax | 281-420-1272
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1001 W BAKER RD STE 100
-----------------------------------------------------
City | BAYTOWN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77521-2385
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-427-6525
-----------------------------------------------------
Fax | 281-420-1272
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP-BC
-----------------------------------------------------
Name | MIRANDA C HARRIS
-----------------------------------------------------
Credential | APRN,FNP-BC
-----------------------------------------------------
Telephone | 281-427-6525
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------