Provider Demographics
NPI:1700576824
Name:OTT, TROI NOELLE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TROI
Middle Name:NOELLE
Last Name:OTT
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:TROI
Other - Middle Name:NOELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:414 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:TX
Mailing Address - Zip Code:76065-5580
Mailing Address - Country:US
Mailing Address - Phone:214-437-6292
Mailing Address - Fax:
Practice Address - Street 1:4401 PARK SPRINGS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1935
Practice Address - Country:US
Practice Address - Phone:817-960-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT64002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty