Provider Demographics
NPI:1093073058
Name:MCGREW, JOELLA DAWN (OT)
Entity Type:Individual
Prefix:MRS
First Name:JOELLA
Middle Name:DAWN
Last Name:MCGREW
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MISS
Other - First Name:JOELLA
Other - Middle Name:DAWN
Other - Last Name:KEITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:515 W MAIN ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8000
Mailing Address - Country:US
Mailing Address - Phone:214-509-6961
Mailing Address - Fax:214-382-0943
Practice Address - Street 1:515 W MAIN ST
Practice Address - Street 2:SUITE 111
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8000
Practice Address - Country:US
Practice Address - Phone:214-509-6961
Practice Address - Fax:214-382-0943
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110078225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics