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General NPI Number Information
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NPI Number | 1295218741
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Entity Type | Individual
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Provider Name | ADRIANNA TATUM
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Gender | Female
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 8017 W VIRGINIA DR
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City | DALLAS
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State | TX
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Zip | 75237-3767
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Country | US
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Telephone | 972-709-1112
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Fax |
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Provider Business Mailing Address
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Address Line | 4713 VIRGINIA AVE STE D
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City | DALLAS
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State | TX
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Zip | 75204-4806
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Country | US
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Telephone | 972-339-8098
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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 | 215191
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License Number State | TX
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