Individual
JANICE KAYE MCCULLOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
406 S MAIN ST, WINNSBORO, TX 75494-3226
(903) 342-6790
(903) 342-6796
Mailing address
1699 WOOD PL, LONGVIEW, TX 75601-4047
(903) 918-5532
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
105273
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105273
OCCUPATIONAL LICENSE
TX
Enumeration date
08/01/2018
Last updated
08/01/2018
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