Provider Demographics
NPI:1942516869
Name:GOLDEN, LOLITA CRESHANDA (OT)
Entity Type:Individual
Prefix:
First Name:LOLITA
Middle Name:CRESHANDA
Last Name:GOLDEN
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 1:1413 SUZANNE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-5882
Mailing Address - Country:US
Mailing Address - Phone:334-303-1090
Mailing Address - Fax:972-559-1867
Practice Address - Street 1:12222 N CENTRAL EXPY
Practice Address - Street 2:SUITE 115
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-3720
Practice Address - Country:US
Practice Address - Phone:972-546-0411
Practice Address - Fax:972-559-1867
Is Sole Proprietor?:No
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112508225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist