Provider Demographics
NPI:1780855627
Name:COLBURN, TANEE BROOKE (OT)
Entity Type:Individual
Prefix:MRS
First Name:TANEE
Middle Name:BROOKE
Last Name:COLBURN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 COUNTY ROAD 265
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:TX
Mailing Address - Zip Code:77975-4878
Mailing Address - Country:US
Mailing Address - Phone:361-772-4921
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH LANCASTER STREET
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:TX
Practice Address - Zip Code:77975
Practice Address - Country:US
Practice Address - Phone:361-596-7373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112292225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist