MEDICARE: DIONISE M HEREDIA-THOMAS

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	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1891355764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIONISE M HEREDIA-THOMAS

Provider Business Mailing Address
First Line	:	1325 MAIN ST STE 903
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-0109
Country	:	US
Telephone Number	:	361-537-8463
Fax Number	:	713-838-0926

Provider Business Practice Location Address
First Line	:	24624 INTERSTATE 45 N STE 200
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-4084
Country	:	US
Telephone Number	:	832-680-3561
Fax Number	:	832-261-9945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/13/2019
Last Update Date	:	07/22/2025

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