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General NPI Number Information
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NPI Number | 1073958039
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Entity Type | Individual
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Provider Name | TELETHA LASHONE DANIELS OTA
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Gender | Female
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Dates
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Enumeration Date | 05/05/2013
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 705 HIGHWAY 418 W
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City | SILSBEE
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State | TX
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Zip | 77656
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Country | US
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Telephone | 409-385-0033
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Fax |
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Provider Business Mailing Address
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Address Line | 1665 LINNS WAY
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City | BEAUMONT
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State | TX
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Zip | 77706-3153
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Country | US
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Telephone | 409-291-6329
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Fax |
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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 | 212144
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License Number State | TX
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