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NPI Code Detail

MEDICARE: MIDGE L LITLE OTR

MEDICARE: MIDGE L LITLE 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
1225X00000XOccupational Therapist108241TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18T6111OTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1356450001
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIDGE L LITLE OTR
Provider Business Mailing Address
First Line : 2906 BIG BEN LN
Second Line :
City : GARLAND
State : TX
Zip : 75044
Country : US
Telephone Number : 469-583-1793
Fax Number :
Provider Business Practice Location Address
First Line : 1410 14TH ST
Second Line :
City : PLANO
State : TX
Zip : 75074-6302
Country : US
Telephone Number : 972-424-0148
Fax Number : 972-422-5275
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 03/01/2017

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Directions to “ MIDGE L LITLE OTR” Practice Location

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