Provider Demographics
NPI:1508415076
Name:DUCKWORTH, TRENA SUE (MOT, OTR/L, CBIS)
Entity Type:Individual
Prefix:
First Name:TRENA
Middle Name:SUE
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:MOT, OTR/L, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4277 COUNTY ROAD 1089
Mailing Address - Street 2:
Mailing Address - City:CELESTE
Mailing Address - State:TX
Mailing Address - Zip Code:75423-4991
Mailing Address - Country:US
Mailing Address - Phone:972-658-5051
Mailing Address - Fax:
Practice Address - Street 1:909 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1520
Practice Address - Country:US
Practice Address - Phone:214-820-9322
Practice Address - Fax:214-818-7990
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116830225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist