Provider Demographics
NPI:1285079301
Name:VARGHESE, JOBY (OTR/L)
Entity type:Individual
Prefix:
First Name:JOBY
Middle Name:
Last Name:VARGHESE
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 N MACARTHUR BLVD
Mailing Address - Street 2:650
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3651
Mailing Address - Country:US
Mailing Address - Phone:267-973-4770
Mailing Address - Fax:
Practice Address - Street 1:3501 N MACARTHUR BLVD
Practice Address - Street 2:650
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-3651
Practice Address - Country:US
Practice Address - Phone:267-973-4770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115116225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist