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NPI Code Detail

MEDICARE: DWAIN RAY KLOSTERMANN OT

MEDICARE: DWAIN RAY KLOSTERMANN OT
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 Therapist100807TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A008OTHERTRICARE
28T0879OTHERBCBS

General Provider Information

NPI Number : 1699769604
Entity Type Code : Individual
Provider Name (Legal Business Name) : DWAIN RAY KLOSTERMANN OT
Provider Business Mailing Address
First Line : 4601 HARTFORD ST
Second Line :
City : ABILENE
State : TX
Zip : 79605-4603
Country : US
Telephone Number : 325-793-3400
Fax Number : 325-793-3534
Provider Business Practice Location Address
First Line : 4601 HARTFORD ST
Second Line :
City : ABILENE
State : TX
Zip : 79605-4603
Country : US
Telephone Number : 325-793-3400
Fax Number : 325-793-3534
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2005
Last Update Date : 09/30/2013

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Directions to “ DWAIN RAY KLOSTERMANN OT” Practice Location

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