Provider Demographics
NPI:1194923748
Name:TODD, JOHN MAXWELL (OT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MAXWELL
Last Name:TODD
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8561 OLD RELIANCE RD
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77808-8435
Mailing Address - Country:US
Mailing Address - Phone:979-820-1547
Mailing Address - Fax:
Practice Address - Street 1:1022 PRESIDENTIAL CORRIDOR
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-4611
Practice Address - Country:US
Practice Address - Phone:979-567-0920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109180171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor