1386758076 NPI number — MARIAN A WHEELER O.T.

Table of content: MARIAN A WHEELER O.T. (NPI 1386758076)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386758076 NPI number — MARIAN A WHEELER O.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
MARIAN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386758076
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9301 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75231-0806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-220-2468
Provider Business Mailing Address Fax Number:
214-397-1555

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9301 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75231-0806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-220-2468
Provider Business Practice Location Address Fax Number:
214-397-1555
Provider Enumeration Date:
08/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  775 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X , with the licence number: 103158 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)