Healthcare Provider Details

I. General information

NPI: 1669064051
Provider Name (Legal Business Name): CHRISTAL BRENAE CULBERTSON OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2021
Last Update Date: 02/07/2021
Certification Date: 02/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6502 SLIDE RD STE 204
LUBBOCK TX
79424-1311
US

IV. Provider business mailing address

6502 SLIDE RD STE 204
LUBBOCK TX
79424-1311
US

V. Phone/Fax

Practice location:
  • Phone: 806-686-0429
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number121434
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: