Provider Demographics
NPI:1386224277
Name:CULBREATH, HALLI BROOK (COTA/L)
Entity Type:Individual
Prefix:
First Name:HALLI
Middle Name:BROOK
Last Name:CULBREATH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 N LOY LAKE RD STE J
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-2837
Mailing Address - Country:US
Mailing Address - Phone:903-487-5520
Mailing Address - Fax:903-496-0004
Practice Address - Street 1:2001 N LOY LAKE RD STE J
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-2837
Practice Address - Country:US
Practice Address - Phone:903-487-5520
Practice Address - Fax:903-496-0004
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216706224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant