Stacie Deleon Arevalo, COTA

Individual provider Active NPI Occupational Therapy Assistant · Joshua, TX

NPI 1669993234 · NPPES record last updated Mar 17, 2018

Key facts

NPI
1669993234
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
213102 (TX)
Practice address
310 E 18TH St
Joshua, TX 76058-3117
Phone
(817) 202-2500
NPI assigned
Jul 4, 2017
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
213102TXMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Small Hands Big Hearts Pediatric Therapy Management Inc Past Accepting new patients

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 213102 TX Yes

Addresses

Primary practice location

310 E 18TH St
Joshua, TX 76058-3117

Mailing address

4014 Bay Springs CT
Arlington, TX 76016-4744
Phone (817) 773-4554

Other practice location 1

404 Racquet Club Blvd
Bedford, TX 76022-6408
Phone (682) 738-3056

Other identifiers

IdentifierTypeStateIssuer
213102OtherTXTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS

Other providers in Joshua, TX

All providers in Joshua, TX · Occupational Therapy Assistant in Texas

Sources for this page

Verify at the official NPI Registry.