Healthcare Provider Details

I. General information

NPI: 1659102424
Provider Name (Legal Business Name): MAKAYLA CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2024
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 E COPELAND RD STE 300
ARLINGTON TX
76011-4910
US

IV. Provider business mailing address

511 RANCH VIEW RD
PERRIN TX
76486-3329
US

V. Phone/Fax

Practice location:
  • Phone: 817-505-2575
  • Fax:
Mailing address:
  • Phone: 682-400-7213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number218458
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: