=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801346903
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID RICHARD WORLEY OTR
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/12/2016
-----------------------------------------------------
Last Update Date | 10/12/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1033 RICHMOND LN
-----------------------------------------------------
City | FORNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75126-6518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-474-1759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1033 RICHMOND LN
-----------------------------------------------------
City | FORNEY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75126-6518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-474-1759
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 107478
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------