=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386865608
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INDUSTRIAL MED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2420 E RANDOL MILL RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76011-6335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-394-1010
-----------------------------------------------------
Fax | 817-394-1017
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2420 E RANDOL MILL RD
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76011-6335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-394-1010
-----------------------------------------------------
Fax | 817-394-1017
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | STELLA HANNAH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 817-394-1010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | NA
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------