Provider Demographics
NPI:1043888571
Name:WHITLOW, JOSEPH
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:WHITLOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14753 COUNTY ROAD 3161
Mailing Address - Street 2:
Mailing Address - City:MOUNT ENTERPRISE
Mailing Address - State:TX
Mailing Address - Zip Code:75681-7572
Mailing Address - Country:US
Mailing Address - Phone:903-722-5343
Mailing Address - Fax:
Practice Address - Street 1:14753 COUNTY ROAD 3161
Practice Address - Street 2:
Practice Address - City:MOUNT ENTERPRISE
Practice Address - State:TX
Practice Address - Zip Code:75681-7572
Practice Address - Country:US
Practice Address - Phone:903-722-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212464224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant