Provider Demographics
NPI:1285117580
Name:CREEL, DONELL ELAINE (COTA)
Entity type:Individual
Prefix:
First Name:DONELL
Middle Name:ELAINE
Last Name:CREEL
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:TX
Mailing Address - Zip Code:76648-2343
Mailing Address - Country:US
Mailing Address - Phone:469-939-3522
Mailing Address - Fax:
Practice Address - Street 1:401 OWEN LN
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-5558
Practice Address - Country:US
Practice Address - Phone:254-772-8900
Practice Address - Fax:254-772-2970
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX206070224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification