Provider Demographics
NPI:1972141646
Name:PRUITT, EILISH (OTR/L)
Entity type:Individual
Prefix:
First Name:EILISH
Middle Name:
Last Name:PRUITT
Suffix:
Gender:F
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 1:1000 TOURMALINE CV
Mailing Address - Street 2:
Mailing Address - City:OAK POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75068-2281
Mailing Address - Country:US
Mailing Address - Phone:214-552-4480
Mailing Address - Fax:
Practice Address - Street 1:5000 LONG PRAIRIE RD STE 200
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2797
Practice Address - Country:US
Practice Address - Phone:214-222-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120422225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist