Provider Demographics
NPI:1093866816
Name:DOBBS, TINA LEA (OTR)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LEA
Last Name:DOBBS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MC 290
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854
Mailing Address - Country:US
Mailing Address - Phone:903-277-8678
Mailing Address - Fax:
Practice Address - Street 1:500 S MAIN
Practice Address - Street 2:SCHOOL OF HOPE
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801
Practice Address - Country:US
Practice Address - Phone:870-777-4501
Practice Address - Fax:870-777-4945
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR 1802225X00000X
TX110719225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX021289601Medicaid