Basic Information
| Provider Information | |||||||||
| NPI: | 1659819571 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEED REHABILITATION INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 E FERNHURST DR | ||||||||
| Address2: | 329 | ||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774501431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135600168 | ||||||||
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| Practice Location | |||||||||
| Address1: | 535 E FERNHURST DR | ||||||||
| Address2: | 329 | ||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774501431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7135600168 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2017 | ||||||||
| LastUpdateDate: | 02/11/2017 | ||||||||
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| AuthorizedOfficialLastName: | PAYNE | ||||||||
| AuthorizedOfficialFirstName: | CHERYL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7135600168 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS,CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 18821 | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 101973 | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | 105178 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 1003008145 | 05 | TX | MEDICAID | 1073829396 | 05 | TX | MEDICAID | 1427286053 | 05 | TX | MEDICAID |