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NPI Code Detail

MEDICARE: BLUEBONNET PEDIATRIC THERAPY LLC

MEDICARE: BLUEBONNET PEDIATRIC THERAPY LLC
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
1225XP0200XPediatric Occupational Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11457606469OTHERNPI

General Provider Information

NPI Number : 1982358420
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUEBONNET PEDIATRIC THERAPY LLC
Provider Business Mailing Address
First Line : 18 SCENIC LOOP RD STE 200D
Second Line :
City : BOERNE
State : TX
Zip : 78006-8672
Country : US
Telephone Number : 830-755-0098
Fax Number : 830-327-0099
Provider Business Practice Location Address
First Line : 18 SCENIC LOOP RD # 200D
Second Line :
City : BOERNE
State : TX
Zip : 78006-8672
Country : US
Telephone Number : 817-800-4431
Fax Number :
Authorized Official
Title or Position : OCCUPATIONAL THERAPIST
Name : REBEKAH KAY GILMORE
Credential : OTR/L
Telephone Number : 817-800-4431
Provider Enumeration Date : 02/03/2022
Last Update Date : 12/02/2024

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Directions to “BLUEBONNET PEDIATRIC THERAPY LLC ” Practice Location

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