Provider Demographics
NPI:1902409774
Name:ELDER-GOTTA, DARCELLE (MOTR/L)
Entity Type:Individual
Prefix:
First Name:DARCELLE
Middle Name:
Last Name:ELDER-GOTTA
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 HUGULEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7506
Mailing Address - Country:US
Mailing Address - Phone:817-551-5900
Mailing Address - Fax:
Practice Address - Street 1:301 HUGULEY BLVD
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7506
Practice Address - Country:US
Practice Address - Phone:817-551-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121165225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist