Provider Demographics
NPI:1275551459
Name:RANKIN, CONNIE GAYLE (OTR)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:GAYLE
Last Name:RANKIN
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 1:7215 STONEWALL DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-0917
Mailing Address - Country:US
Mailing Address - Phone:903-831-4511
Mailing Address - Fax:
Practice Address - Street 1:4303 TEXAS BLVD
Practice Address - Street 2:SUITE 8
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-3097
Practice Address - Country:US
Practice Address - Phone:903-793-1797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103929225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86941TOtherBCBS
AR99453OtherBCBS