Provider Demographics
NPI:1679205678
Name:DOBBS, DERRICK ROY (ATP)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:ROY
Last Name:DOBBS
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 TOPAZ CIR
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-2997
Mailing Address - Country:US
Mailing Address - Phone:254-447-7962
Mailing Address - Fax:
Practice Address - Street 1:1340 AIRPORT COMMERCE DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-6831
Practice Address - Country:US
Practice Address - Phone:254-447-7962
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-28
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
95655225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology Practitioner
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other