Provider Demographics
NPI:1104148071
Name:NORTH CARRIER OCCUPATIONAL THERAPY ASSOCIATE, LLC
Entity type:Organization
Organization Name:NORTH CARRIER OCCUPATIONAL THERAPY ASSOCIATE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:URIBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-325-7022
Mailing Address - Street 1:517 N CARRIER PKWY STE H
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5464
Mailing Address - Country:US
Mailing Address - Phone:214-325-7022
Mailing Address - Fax:
Practice Address - Street 1:517 N CARRIER PKWY STE H
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5464
Practice Address - Country:US
Practice Address - Phone:214-325-7022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine