Healthcare Provider Details

I. General information

NPI: 1417604356
Provider Name (Legal Business Name): EMILY WOMACK OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2022
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 GREEN HOLLOW DR
TEMPLE TX
76502-6126
US

IV. Provider business mailing address

370 GREEN HOLLOW DR
TEMPLE TX
76502-6126
US

V. Phone/Fax

Practice location:
  • Phone: 254-780-9658
  • Fax: 254-442-8088
Mailing address:
  • Phone: 254-780-9658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number122546
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number122546
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: