=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952016156
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SERVING HANDS ABA , PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/23/2023
-----------------------------------------------------
Last Update Date | 01/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 465 CHAMBERS PL
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-897-0405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 465 CHAMBERS PL
-----------------------------------------------------
City | FAIRVIEW
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75069-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-897-0405
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | PHILIP ALAN BOETTCHER
-----------------------------------------------------
Credential | DNP
-----------------------------------------------------
Telephone | 214-897-0405
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------