MEDICARE: M HOPE PARKS OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	110056	TX

General Provider Information

NPI Number	:	1053878520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	M HOPE PARKS OTR

Provider Business Mailing Address
First Line	:	1102 CLEARVIEW DR
Second Line	:
City	:	ALLEN
State	:	TX
Zip	:	75002-2036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4524 BOAT CLUB RD STE 154
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76135-7025
Country	:	US
Telephone Number	:	817-345-7530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2019
Last Update Date	:	02/20/2019

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Directions to “ M HOPE PARKS OTR” Practice Location

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