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NPI Code Detail

MEDICARE: OCOTILLO REHAB MEDICINE PLLC

MEDICARE: OCOTILLO REHAB MEDICINE PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1285250506
Entity Type Code : Organization
Provider Name (Legal Business Name) : OCOTILLO REHAB MEDICINE PLLC
Provider Business Mailing Address
First Line : 1317 BONHAM TER
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2606
Country : US
Telephone Number : 713-501-1461
Fax Number : 818-671-2225
Provider Business Practice Location Address
First Line : 330 W BEN WHITE BLVD
Second Line :
City : AUSTIN
State : TX
Zip : 78704-8095
Country : US
Telephone Number : 512-730-4800
Fax Number : 818-671-2225
Authorized Official
Title or Position : OWNER
Name : JON-MICHAEL RESURRECCION ONG
Credential : MD
Telephone Number : 713-501-1461
Provider Enumeration Date : 06/23/2020
Last Update Date : 06/23/2020

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Directions to “OCOTILLO REHAB MEDICINE PLLC ” Practice Location

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