Basic Information
| Provider Information | |||||||||
| NPI: | 1285250506 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCOTILLO REHAB MEDICINE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1317 BONHAM TER | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787042606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135011461 | ||||||||
| FaxNumber: | 8186712225 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 W BEN WHITE BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787048095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5127304800 | ||||||||
| FaxNumber: | 8186712225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2020 | ||||||||
| LastUpdateDate: | 06/23/2020 | ||||||||
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| AuthorizedOfficialLastName: | ONG | ||||||||
| AuthorizedOfficialFirstName: | JON-MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | RESURRECCION | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7135011461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.