Basic Information
| Provider Information | |||||||||
| NPI: | 1891355764 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HEREDIA-THOMAS | ||||||||
| FirstName: | DIONISE | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17810 RUNNING BROOK LN | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773796142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615378463 | ||||||||
| FaxNumber: | 7138380926 | ||||||||
| Practice Location | |||||||||
| Address1: | 24624 INTERSTATE 45 N STE 200 | ||||||||
| Address2: | |||||||||
| City: | SPRING | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773864084 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8326803561 | ||||||||
| FaxNumber: | 8322619945 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2019 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.