Provider Demographics
NPI:1790009959
Name:FELTON, TY
Entity Type:Individual
Prefix:
First Name:TY
Middle Name:
Last Name:FELTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 TOWER DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4239
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 TOWER DR
Practice Address - Street 2:SUITE 7
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4239
Practice Address - Country:US
Practice Address - Phone:432-335-8777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113532225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist