Healthcare Provider Details

I. General information

NPI: 1972652527
Provider Name (Legal Business Name): DINA DENISE PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4642 N LOOP 289 STE 105
LUBBOCK TX
79416-2422
US

IV. Provider business mailing address

4642 N LOOP 289 STE 105
LUBBOCK TX
79416-2422
US

V. Phone/Fax

Practice location:
  • Phone: 806-771-3030
  • Fax:
Mailing address:
  • Phone: 806-771-3030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License NumberOT003218
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: