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Organization

REGION III EDUCATION SERVICE CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
ANGIE MARIE BOLOM OTR (COORDINATOR OF THERAPY SERVICES)
(361) 573-0731
Entity
Organization

Contact information

Practice address
1905 LEARY LN, VICTORIA, TX 77901-2818
(361) 573-0731
(361) 573-1594
Mailing address
1905 LEARY LN, VICTORIA, TX 77901-2818
(361) 573-0731
(361) 573-1594

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
133V00000X
Registered Dietitian
225100000X
Physical Therapist
225X00000X
Occupational Therapist
235Z00000X
Speech-Language Pathologist
252Y00000X
Early Intervention Provider Agency
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
017427801
TX
Enumeration date
11/21/2006
Last updated
06/12/2024
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