Provider Demographics
NPI:1356450001
Name:LITLE, MIDGE L (OTR)
Entity Type:Individual
Prefix:
First Name:MIDGE
Middle Name:L
Last Name:LITLE
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:MIDGE
Other - Middle Name:L
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR
Mailing Address - Street 1:2906 BIG BEN LN
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044
Mailing Address - Country:US
Mailing Address - Phone:469-583-1793
Mailing Address - Fax:
Practice Address - Street 1:1410 14TH ST
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6302
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:972-422-5275
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108241225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6111OtherBLUE CROSS BLUE SHIELD