Provider Demographics
NPI:1902388705
Name:PATTERSON TEKELL, JOHNNA (OTR)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:
Last Name:PATTERSON TEKELL
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 PINE MILL RD
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75462-5172
Mailing Address - Country:US
Mailing Address - Phone:903-517-5642
Mailing Address - Fax:
Practice Address - Street 1:4180 PINE MILL RD
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462-5172
Practice Address - Country:US
Practice Address - Phone:903-517-5642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114042225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist