Provider Demographics
NPI:1164815882
Name:PRINDLE, MARA
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:
Last Name:PRINDLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 WITTINGTON PL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-1927
Mailing Address - Country:US
Mailing Address - Phone:214-442-4000
Mailing Address - Fax:866-534-5697
Practice Address - Street 1:369 MARS DR
Practice Address - Street 2:
Practice Address - City:COTULLA
Practice Address - State:TX
Practice Address - Zip Code:78014-3146
Practice Address - Country:US
Practice Address - Phone:214-442-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116475225X00000X
FLOT16672225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist