Organization
ANGEL LEAF HOME CARE PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDNA LUCIO OTR (OCCUPATIONAL THERAPIST)
(979) 418-7165
Entity
Organization
Contact information
Practice address
309 PLANTATION DR, LAKE JACKSON, TX 77566-6142
(979) 418-7165
(800) 419-5153
Mailing address
337 SHERI LN, LAKE JACKSON, TX 77566-3269
(979) 418-7165
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225100000X
Physical Therapist
—
—
2251P0200X
Pediatric Physical Therapist
—
—
225200000X
Physical Therapy Assistant
—
—
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
021439
AGENCY LICENSE
TX
Enumeration date
05/25/2022
Last updated
01/20/2023
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