Jeremy Brad King, COTA

Individual provider Active NPI Occupational Therapy Assistant · Haskell, TX

NPI 1073718367 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1073718367
Entity type
Individual (NPI type 1)
Primary specialty
Occupational Therapy Assistant 224Z00000X
License
208771 (TX)
Practice address
1504 N 1St St
Haskell, TX 79521-5438
Phone
(940) 864-2932
NPI assigned
Jun 18, 2007
Sex
Male
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
208771TXMDOccupational Therapy Assistant

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X 208771 TX Yes

Addresses

Primary practice location

1504 N 1St St
Haskell, TX 79521-5438

Mailing address

190 Sugar Biscuit LN
Abilene, TX 79602-5546
Phone (325) 698-5045

Other providers in Haskell, TX

All providers in Haskell, TX · Occupational Therapy Assistant in Texas

Sources for this page

Verify at the official NPI Registry.