Provider Demographics
NPI:1750882205
Name:NIC-DREW, INC.
Entity type:Organization
Organization Name:NIC-DREW, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHARINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OT
Authorized Official - Phone:512-520-6598
Mailing Address - Street 1:105 EAGLE CV
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5010
Mailing Address - Country:US
Mailing Address - Phone:512-520-6598
Mailing Address - Fax:855-779-1943
Practice Address - Street 1:105 EAGLE CV
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-5010
Practice Address - Country:US
Practice Address - Phone:512-520-6598
Practice Address - Fax:855-779-1943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106088OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS