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Individual

TRICIA BLACKWELDER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
11751 ALTA VISTA RD STE 201, FORT WORTH, TX 76244-6442
(817) 562-1006
(817) 562-1009
Mailing address
11751 ALTA VISTA RD STE 201, FORT WORTH, TX 76244-6442
(817) 562-1006
(817) 562-1009

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
216740
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
216740
EXECUTIVE COUNCIL OF PHYSICAL THERAPY AND OCCUPATIONAL THERAPY EXAMINERS
TX
01
451290
NBCOT
Enumeration date
03/15/2021
Last updated
03/15/2021
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