Individual
JAMY C. BLACK MCCOLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
3840 HULEN ST, FORT WORTH, TX 76107-7277
(817) 569-4413
Mailing address
PO BOX 2603, FORT WORTH, TX 76113-2603
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
108663
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
287142801
—
TX
01
—
29179-6
BLUE CROSS
RI
01
—
409159
BLUE CHIP RI
RI
01
—
873P63
BLUE CROSS BLUE SHIELD
TX
Enumeration date
03/05/2007
Last updated
06/10/2012
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