Provider Demographics
NPI:1861201733
Name:WEDIVERGE LLC
Entity type:Organization
Organization Name:WEDIVERGE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARIA THERESA LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:OTR, OTD
Authorized Official - Phone:832-672-2144
Mailing Address - Street 1:9757 PINE LAKE DR APT 3059
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6163
Mailing Address - Country:US
Mailing Address - Phone:832-672-2144
Mailing Address - Fax:
Practice Address - Street 1:9757 PINE LAKE DR APT 3059
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6163
Practice Address - Country:US
Practice Address - Phone:832-672-2144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-04
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty