Individual
JUSTIN WALLACE THIBERVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
4601 HARTFORD ST, ABILENE, TX 79605-4603
(325) 793-3400
(325) 793-3587
Mailing address
4601 HARTFORD ST, ABILENE, TX 79605-4603
(325) 793-3400
(325) 793-3587
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
111790
TX
Other
Enumeration date
11/30/2006
Last updated
07/08/2007
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