Healthcare Provider Details

I. General information

NPI: 1396402285
Provider Name (Legal Business Name): DESARAE HELI OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2021
Last Update Date: 02/07/2024
Certification Date: 02/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

578 S WHEAT RD
BELTON TX
76513-7134
US

IV. Provider business mailing address

4900 SANGER AVE
WACO TX
76710-5866
US

V. Phone/Fax

Practice location:
  • Phone: 254-598-2620
  • Fax: 254-848-4193
Mailing address:
  • Phone: 254-644-2423
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: