Provider Demographics
NPI:1720569957
Name:WEBB, DONALD DEBRELLE (COTA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:DEBRELLE
Last Name:WEBB
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 1:1712 STERLING TRACE DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-8746
Mailing Address - Country:US
Mailing Address - Phone:817-412-1845
Mailing Address - Fax:
Practice Address - Street 1:1250 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6245
Practice Address - Country:US
Practice Address - Phone:817-226-0500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-26
Last Update Date:2018-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206045224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant