# FUN HOUSE REHAB, LLC

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

## Provider details

- **NPI number:** 1447711528
- **Authorized official:** NOE BAZAN OTR (OWNER)
- **Authorized official phone:** (956) 638-0761

## Contact information

- **Practice address:** 11837 ACOSTA CIR W, MISSION, TX 78573-7995
- **Practice address phone:** (956) 638-0761
- **Mailing address:** 9620 STATE HIGHWAY 107, MISSION, TX 78573-8495
- **Mailing address phone:** (956) 638-0761
- **Mailing address fax:** (956) 329-2830

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225X00000X | Occupational Therapist | — | NULL | Yes |
| 225X00000X | Occupational Therapist | — | — | Yes |

## Other

- **Enumeration date:** 03/29/2019
- **Last updated:** 04/08/2019