Basic Information
| Provider Information | |||||||||
| NPI: | 1235519430 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEVELOPMENTAL REHAB SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 111878 | ||||||||
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| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7133202670 | ||||||||
| FaxNumber: | 7135837597 | ||||||||
| Practice Location | |||||||||
| Address1: | 20817 SUNSHINE LN | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773884838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2817864234 | ||||||||
| FaxNumber: | 7135837597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2015 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | PIERCE | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7133202670 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | OTR | ||||||||
| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XP0200X | 113673 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 402230301 | 05 | TX | MEDICAID | 402230302 | 05 | TX | MEDICAID |