Provider Demographics
NPI:1356454342
Name:FLAGLE, JUDITH R
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:R
Last Name:FLAGLE
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 1:2400 LAKEVIEW DR STE 102
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-1532
Mailing Address - Country:US
Mailing Address - Phone:806-468-9400
Mailing Address - Fax:806-468-9401
Practice Address - Street 1:2400 LAKEVIEW DR STE 102
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1532
Practice Address - Country:US
Practice Address - Phone:806-468-9400
Practice Address - Fax:806-468-9401
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100501225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T1107;8T1539OtherBCBS
TX089144204Medicaid