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General NPI Number Information
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NPI Number | 1780855627
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Entity Type | Individual
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Provider Name | TANEE BROOKE COLBURN OT
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Gender | Female
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Dates
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Enumeration Date | 03/19/2008
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 101 SOUTH LANCASTER STREET
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City | MOULTON
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State | TX
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Zip | 77975
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Country | US
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Telephone | 361-596-7373
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Fax |
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Provider Business Mailing Address
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Address Line | 3841 COUNTY ROAD 265
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City | MOULTON
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State | TX
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Zip | 77975-4878
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Country | US
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Telephone | 361-772-4921
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 112292
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License Number State | TX
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