Healthcare Provider Details

I. General information

NPI: 1669497673
Provider Name (Legal Business Name): ROBERT E WEST O.T.R.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10300 N CENTRAL EXPY
DALLAS TX
75231-8600
US

IV. Provider business mailing address

8005 TWIN OAKS DR
MC KINNEY TX
75070-8535
US

V. Phone/Fax

Practice location:
  • Phone: 214-370-0404
  • Fax: 214-370-9880
Mailing address:
  • Phone: 214-504-9267
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number110043
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: