Provider Demographics
NPI:1306967740
Name:RICHARDSON, VANESSA KAY (OTR)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:KAY
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:KAY
Other - Last Name:MULLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9405 TERENCE DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-4854
Mailing Address - Country:US
Mailing Address - Phone:972-412-1219
Mailing Address - Fax:
Practice Address - Street 1:2535 LONE STAR DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75212-6313
Practice Address - Country:US
Practice Address - Phone:214-467-9787
Practice Address - Fax:214-741-3655
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100642225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist