Provider Demographics
NPI:1215722350
Name:WOLF, VICTORIA ROSE (OTR, OTD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:ROSE
Last Name:WOLF
Suffix:
Gender:
Credentials:OTR, OTD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:ROSE
Other - Last Name:WILBURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3653 W WALNUT HILL LN APT 1123
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-4015
Mailing Address - Country:US
Mailing Address - Phone:903-951-0726
Mailing Address - Fax:
Practice Address - Street 1:1431 GREENWAY DR STE 500
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-2444
Practice Address - Country:US
Practice Address - Phone:877-688-2520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX125467225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist