Organization
COWBOY UP THERAPIES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLEY WARREN JEWART MS, CCC-SLP (EXECUTIVE DIRECTOR AND SLP)
(713) 336-3419
Entity
Organization
Contact information
Practice address
27902 MOUND RD, HOCKLEY, TX 77447-8295
(713) 336-3419
Mailing address
27902 MOUND RD, HOCKLEY, TX 77447-8295
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
—
—
225800000X
Recreation Therapist
—
—
235Z00000X
Speech-Language Pathologist
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
UNKNOWN
PRIVATE PAY
TX
Enumeration date
10/14/2021
Last updated
10/14/2021
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