MEDICARE: GREGORY L WATTRON O.T.R.

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	225X00000X	Occupational Therapist	104227	TX

General Provider Information

NPI Number	:	1568680650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY L WATTRON O.T.R.

Provider Business Mailing Address
First Line	:	2351 W NORTHWEST HWY
Second Line	:	SUITE 3100
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-352-3000
Fax Number	:	214-358-2418

Provider Business Practice Location Address
First Line	:	2351 W NORTHWEST HWY
Second Line	:	SUITE 3100
City	:	DALLAS
State	:	TX
Zip	:	75220-4433
Country	:	US
Telephone Number	:	214-352-3000
Fax Number	:	214-358-2418

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

Provider Enumeration Date	:	04/23/2007
Last Update Date	:	07/08/2007

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