| Organization Name: | ORIGINS BIRTH SERVICES, LLC |
| NPI Number: | 1003211756 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KAITLYN ELIZABETH WAGES (MIDWIFE/OWNER) |
| Mailing Address: | 10340 Alta Vista Rd Suite 1a Fort Worth |
| State: | TX US |
| Postal Code: | 762446500 |
| Phone Number: | 8175622828 |
| Fax Number: | 8177686940 |
| NPI Enumeration Date: | 10/23/2014 |
| NPI Last Update Date: | 10/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 175M00000X |
| License Number: | 99220 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Midwife, Lay |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person qualified by experience and limited specialized training to provide obstetric and neo-natal care in the management of women having normal pregnancy, labor and childbirth. The lay midwife is licensed in some states. |