Healthcare Provider Details

I. General information

NPI: 1326486614
Provider Name (Legal Business Name): AMY CONNER POPE OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 S LOOP 289 SUITE 101
LUBBOCK TX
79423-1337
US

IV. Provider business mailing address

3223 S LOOP 289 SUITE 101
LUBBOCK TX
79423-1337
US

V. Phone/Fax

Practice location:
  • Phone: 806-792-5522
  • Fax: 806-785-7582
Mailing address:
  • Phone: 806-792-5522
  • Fax: 806-785-7582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number103805
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: