Provider Demographics
NPI:1831542067
Name:INFINITE LIFE THERAPY
Entity type:Organization
Organization Name:INFINITE LIFE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:PORSCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIRES
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:214-650-9963
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-0004
Mailing Address - Country:US
Mailing Address - Phone:214-650-9963
Mailing Address - Fax:
Practice Address - Street 1:6220 TEXANA WAY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-2075
Practice Address - Country:US
Practice Address - Phone:214-650-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-22
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802502547261Q00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center