MEDICARE: JEFFREY DENNIS PELLET O.T.

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	107871	TX

General Provider Information

NPI Number	:	1780343335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY DENNIS PELLET O.T.

Provider Business Mailing Address
First Line	:	5904 S COOPER ST STE 104107
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-4494
Country	:	US
Telephone Number	:	682-238-3243
Fax Number	:	817-549-0106

Provider Business Practice Location Address
First Line	:	2340 W I 20
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76017-7600
Country	:	US
Telephone Number	:	682-238-3243
Fax Number	:	817-549-0106

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

Provider Enumeration Date	:	12/10/2021
Last Update Date	:	12/10/2021

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