Provider Demographics
NPI:1003508458
Name:WESLEY, STEVEN BROOKES (OT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:BROOKES
Last Name:WESLEY
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W GIBSON ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-4905
Mailing Address - Country:US
Mailing Address - Phone:409-200-1178
Mailing Address - Fax:
Practice Address - Street 1:1209 W BLUFF ST
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:TX
Practice Address - Zip Code:75979-4739
Practice Address - Country:US
Practice Address - Phone:409-200-2804
Practice Address - Fax:409-200-2997
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX123236225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist