Provider Demographics
NPI:1265082283
Name:ESCOBEDO, ROLAND (OTA/L)
Entity type:Individual
Prefix:MR
First Name:ROLAND
Middle Name:
Last Name:ESCOBEDO
Suffix:
Gender:M
Credentials:OTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 BELZ RD
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:TX
Mailing Address - Zip Code:76266-3106
Mailing Address - Country:US
Mailing Address - Phone:940-390-4670
Mailing Address - Fax:
Practice Address - Street 1:1919 BRINKER RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6215
Practice Address - Country:US
Practice Address - Phone:940-380-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208644224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant