Provider Demographics
NPI:1285250506
Name:OCOTILLO REHAB MEDICINE PLLC
Entity type:Organization
Organization Name:OCOTILLO REHAB MEDICINE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON-MICHAEL
Authorized Official - Middle Name:RESURRECCION
Authorized Official - Last Name:ONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-501-1461
Mailing Address - Street 1:1317 BONHAM TER
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2606
Mailing Address - Country:US
Mailing Address - Phone:713-501-1461
Mailing Address - Fax:818-671-2225
Practice Address - Street 1:330 W BEN WHITE BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-8095
Practice Address - Country:US
Practice Address - Phone:512-730-4800
Practice Address - Fax:818-671-2225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-23
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty