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Organization

STAC VENTURES, INC.

Active
Other names
PEDI Telehealth
Organization subpart
No

Provider details

NPI number
Authorized official
JAMES MICHAEL CLARK (PRESIDENT)
(512) 318-4381
Entity
Organization

Contact information

Practice address
1620 SILVER LN, AUBREY, TX 76227-1623
(512) 318-4381
Mailing address
1620 SILVER LN, AUBREY, TX 76227-1623
(512) 318-4381

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary

Other

Enumeration date
03/24/2020
Last updated
03/24/2020
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