Provider Demographics
NPI:1568680650
Name:WATTRON, GREGORY L (OTR)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:L
Last Name:WATTRON
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 W NORTHWEST HWY
Mailing Address - Street 2:SUITE 3100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75220-4433
Mailing Address - Country:US
Mailing Address - Phone:214-352-3000
Mailing Address - Fax:214-358-2418
Practice Address - Street 1:2351 W NORTHWEST HWY
Practice Address - Street 2:SUITE 3100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-4433
Practice Address - Country:US
Practice Address - Phone:214-352-3000
Practice Address - Fax:214-358-2418
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX104227225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist