MEDICARE: MADE2MOVE: THERAPY4KIDS, 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
1	174400000X	Specialist	104786	TX

General Provider Information

NPI Number	:	1871834069
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MADE2MOVE: THERAPY4KIDS, PLLC

Provider Business Mailing Address
First Line	:	11343 N SAM HOUSTON PKWY E
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-4598
Country	:	US
Telephone Number	:	713-254-5541
Fax Number	:	281-441-9081

Provider Business Practice Location Address
First Line	:	4142 VALLEY HAVEN DR
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-1953
Country	:	US
Telephone Number	:	713-254-5541
Fax Number	:	281-441-9081

Authorized Official
Title or Position	:	OT
Name	:	AMANDA LETSOS
Credential	:
Telephone Number	:	713-254-5541

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	04/08/2013

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