Provider Demographics
NPI:1093295206
Name:GREBER, KATHERINE ROLLEIGH (COTA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ROLLEIGH
Last Name:GREBER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4804 WILLOW RUN CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1518
Mailing Address - Country:US
Mailing Address - Phone:318-834-7980
Mailing Address - Fax:318-834-7980
Practice Address - Street 1:301 HUGULEY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7506
Practice Address - Country:US
Practice Address - Phone:817-551-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214368224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant