MEDICARE: CHRISTY LYNN HOBBY OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	105516	TX

General Provider Information

NPI Number	:	1023439049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY LYNN HOBBY OT

Provider Business Mailing Address
First Line	:	1300 W ROSEDALE ST
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2826
Country	:	US
Telephone Number	:	817-377-4011
Fax Number	:	817-377-9269

Provider Business Practice Location Address
First Line	:	1300 W ROSEDALE ST
Second Line	:	SUITE A
City	:	FORT WORTH
State	:	TX
Zip	:	76104-2826
Country	:	US
Telephone Number	:	817-377-4011
Fax Number	:	817-377-9269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/17/2013
Last Update Date	:	12/17/2013

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