Provider Demographics
NPI:1992721666
Name:THERAPEUTIC LIFE SKILLS
Entity type:Organization
Organization Name:THERAPEUTIC LIFE SKILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OCCUPATIONAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRITT
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:817-299-9200
Mailing Address - Street 1:PO BOX 535217
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75053-5217
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:817-299-9222
Practice Address - Street 1:915 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-4924
Practice Address - Country:US
Practice Address - Phone:817-299-9200
Practice Address - Fax:817-299-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108146225X00000X
TX14970235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2750OtherBLUE CROSS/ BLUE SHIELD