Healthcare Provider Details

I. General information

NPI: 1366139370
Provider Name (Legal Business Name): NATASHA WESLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2023
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N WASHINGTON AVE
DALLAS TX
75246
US

IV. Provider business mailing address

110 W CITYLINE DR APT 1071
RICHARDSON TX
75082-3268
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-9593
  • Fax:
Mailing address:
  • Phone: 863-513-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225800000X
TaxonomyRecreation Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: