Provider Demographics
NPI:1295984094
Name:CALVERY, VICKI (OT)
Entity type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:CALVERY
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:PO BOX 3250
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79116-3250
Mailing Address - Country:US
Mailing Address - Phone:806-358-8974
Mailing Address - Fax:806-359-0506
Practice Address - Street 1:2505 LAKEVIEW DR STE 302
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-1523
Practice Address - Country:US
Practice Address - Phone:806-358-8974
Practice Address - Fax:806-359-0506
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109523225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1985830-01Medicaid