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General NPI Number Information
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NPI Number | 1114358272
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Entity Type | Organization
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Legal Business Name | PAULA K. BLACK, OTR
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Dates
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Enumeration Date | 11/27/2013
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Last Update Date | 11/27/2013
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Provider Practice Location Address
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Address Line | 461 CRESTVIEW POINT DR
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City | LEWISVILLE
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State | TX
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Zip | 75067-8349
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Country | US
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Telephone | 214-995-4250
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Fax |
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Provider Business Mailing Address
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Address Line | 461 CRESTVIEW POINT DR
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City | LEWISVILLE
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State | TX
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Zip | 75067-8349
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Country | US
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Telephone | 214-995-4250
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Fax |
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Authorized Official
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Title or Position | OCCUPATIONAL THERAPIST, REGISTERED
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Name | PAULA KATHEEINE BLACK
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Credential | OTR
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Telephone | 214-995-4250
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 109660
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License Number State | TX
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