Provider Demographics
NPI:1972182434
Name:WESSON, TYLER DENISE (OTR/L)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:DENISE
Last Name:WESSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 GIBBS RD
Mailing Address - Street 2:
Mailing Address - City:PIKE ROAD
Mailing Address - State:AL
Mailing Address - Zip Code:36064-2408
Mailing Address - Country:US
Mailing Address - Phone:334-782-1909
Mailing Address - Fax:
Practice Address - Street 1:855 S 8TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4603
Practice Address - Country:US
Practice Address - Phone:409-838-6568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5437225X00000X
TX121712225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist