Provider Demographics
NPI:1538642640
Name:MILLS, LARRY ERNEST (OT)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:ERNEST
Last Name:MILLS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 OVERTON RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76088-7847
Mailing Address - Country:US
Mailing Address - Phone:601-754-9339
Mailing Address - Fax:
Practice Address - Street 1:1715 MARTIN DR
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6738
Practice Address - Country:US
Practice Address - Phone:817-458-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist