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General NPI Number Information
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NPI Number | 1851673248
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Entity Type | Organization
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Legal Business Name | WORKSITE WELLNESS, INC.
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Dates
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Enumeration Date | 09/13/2011
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Last Update Date | 09/13/2011
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Provider Practice Location Address
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Address Line | 3524 SERENDIPITY HILLS TRL
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City | CORINTH
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State | TX
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Zip | 76210-3601
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Country | US
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Telephone | 940-391-6489
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Fax | 940-497-2192
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Provider Business Mailing Address
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Address Line | 3524 SERENDIPITY HILLS TRL
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City | CORINTH
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State | TX
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Zip | 76210-3601
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Country | US
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Telephone | 940-391-6489
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Fax | 940-497-2192
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Authorized Official
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Title or Position | CONSULTANT/OWNER
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Name | GABRIELLE DORAIS
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Credential |
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Telephone | 940-391-6489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0913
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 163WX0106X
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Taxonomy Name | Occupational Health Registered Nurse
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License Number | 576843
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License Number State | TX
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