Provider Demographics
NPI:1477171114
Name:RAGSDALE, LEWIS ALTON (COTA)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:ALTON
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WHIRLAWAY ST
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1221
Mailing Address - Country:US
Mailing Address - Phone:469-951-9386
Mailing Address - Fax:
Practice Address - Street 1:1400 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:TX
Practice Address - Zip Code:75119-1587
Practice Address - Country:US
Practice Address - Phone:972-875-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212395224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant