Provider Demographics
NPI:1780343335
Name:PELLET, JEFFREY DENNIS (OT)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:DENNIS
Last Name:PELLET
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 S COOPER ST STE 104107
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76017-4494
Mailing Address - Country:US
Mailing Address - Phone:682-238-3243
Mailing Address - Fax:817-549-0106
Practice Address - Street 1:2340 W I 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-7600
Practice Address - Country:US
Practice Address - Phone:682-238-3243
Practice Address - Fax:817-549-0106
Is Sole Proprietor?:No
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107871225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist