Individual
DESTINY WALESIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
600 W 3RD ST, BORGER, TX 79007-4008
(806) 274-9856
Mailing address
314 CORONADO ST, FRITCH, TX 79036-8162
(806) 886-1789
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
212171
TX
Other
Enumeration date
07/07/2015
Last updated
07/07/2015
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