Healthcare Provider Details

I. General information

NPI: 1295241503
Provider Name (Legal Business Name): SHAWONDELA WARD OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2017
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 GASTON AVE STE 750
DALLAS TX
75214-3922
US

IV. Provider business mailing address

2078 TAHOKA LN
HEATH TX
75126-2890
US

V. Phone/Fax

Practice location:
  • Phone: 214-295-5374
  • Fax:
Mailing address:
  • Phone: 903-830-7019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number112654
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number112654
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: