Provider Demographics
NPI:1053179747
Name:BASS, NATHAN (OTR/L)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:
Last Name:BASS
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 VOYAGER CV
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6417
Mailing Address - Country:US
Mailing Address - Phone:719-304-9802
Mailing Address - Fax:
Practice Address - Street 1:1351 SADLER DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7775
Practice Address - Country:US
Practice Address - Phone:512-805-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124438225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist