Provider Demographics
NPI:1245821057
Name:WINSOR, BECKY B (OTA)
Entity type:Individual
Prefix:MS
First Name:BECKY
Middle Name:B
Last Name:WINSOR
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:C
Other - Last Name:BERGIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1001 QUAIL VALLEY DR APT 7101
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-8082
Mailing Address - Country:US
Mailing Address - Phone:254-624-6817
Mailing Address - Fax:
Practice Address - Street 1:1001 QUAIL VALLEY DR APT 7101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-8082
Practice Address - Country:US
Practice Address - Phone:254-624-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205000224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant