# ANGEL LEAF HOME CARE PROVIDERS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275271579
- **Authorized official:** EDNA LUCIO OTR (OCCUPATIONAL THERAPIST)
- **Authorized official phone:** (979) 418-7165

## Contact information

- **Practice address:** 309 PLANTATION DR, LAKE JACKSON, TX 77566-6142
- **Practice address phone:** (979) 418-7165
- **Practice address fax:** (800) 419-5153
- **Mailing address:** 337 SHERI LN, LAKE JACKSON, TX 77566-3269
- **Mailing address phone:** (979) 418-7165

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 224Z00000X | Occupational Therapy Assistant | — | NULL | — |
| 224Z00000X | Occupational Therapy Assistant | — | — | — |
| 225100000X | Physical Therapist | — | NULL | — |
| 225100000X | Physical Therapist | — | — | — |
| 2251P0200X | Pediatric Physical Therapist | — | NULL | — |
| 2251P0200X | Pediatric Physical Therapist | — | — | — |
| 225200000X | Physical Therapy Assistant | — | NULL | — |
| 225200000X | Physical Therapy Assistant | — | — | — |
| 225X00000X | Occupational Therapist | — | NULL | — |
| 225X00000X | Occupational Therapist | — | — | — |
| 225XP0200X | Pediatric Occupational Therapist | — | NULL | — |
| 225XP0200X | Pediatric Occupational Therapist | — | — | — |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 05/25/2022
- **Last updated:** 01/20/2023