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General NPI Number Information
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NPI Number | 1003286972
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Entity Type | Individual
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Provider Name | CHADDRICK POLK PT, OTA
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Gender | Male
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Dates
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Enumeration Date | 10/04/2015
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 4261 E UNIVERSITY DR STE 30-165
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City | PROSPER
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State | TX
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Zip | 75078
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Country | US
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Telephone | 972-347-9604
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Fax | 972-499-2527
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Provider Business Mailing Address
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Address Line | 4261 E UNIVERSITY DR STE 30-165
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City | PROSPER
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State | TX
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Zip | 75078-9152
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Country | US
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Telephone | 972-347-9454
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Fax | 972-499-2527
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 213531
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1309289
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License Number State | TX
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