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General NPI Number Information
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NPI Number | 1174759435
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Entity Type | Individual
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Provider Name | TABATHA OPAL RAWAL OT
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Gender | Female
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Dates
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Enumeration Date | 06/01/2009
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Last Update Date | 07/06/2022
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Provider Practice Location Address
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Address Line | 8100 PRECINCT LINE RD
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City | COLLEYVILLE
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State | TX
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Zip | 76034-7674
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Country | US
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Telephone | 682-244-4317
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Fax |
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Provider Business Mailing Address
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Address Line | 2633 GOSLING WAY
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City | FORT WORTH
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State | TX
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Zip | 76118-2035
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Country | US
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Telephone | 304-517-0296
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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 | C1689
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 116390
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License Number State | TX
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