Provider Demographics
NPI:1962867853
Name:OT STAT LLC
Entity type:Organization
Organization Name:OT STAT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:STEFFANIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOURDEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:832-790-6262
Mailing Address - Street 1:5319 MEADOW CANYON DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-8876
Mailing Address - Country:US
Mailing Address - Phone:832-790-6262
Mailing Address - Fax:
Practice Address - Street 1:5319 MEADOW CANYON DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-8876
Practice Address - Country:US
Practice Address - Phone:832-790-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty