Healthcare Provider Details

I. General information

NPI: 1447923818
Provider Name (Legal Business Name): ALLISON OSTDIEK OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2021
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 HARRIS PKWY
FORT WORTH TX
76132-6108
US

IV. Provider business mailing address

4904 PALO BLANCO DR APT 6203
FORT WORTH TX
76109-1316
US

V. Phone/Fax

Practice location:
  • Phone: 817-433-9600
  • Fax:
Mailing address:
  • Phone: 308-380-4691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number121961
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: