Provider Demographics
NPI:1174759435
Name:RAWAL, TABATHA OPAL (OT)
Entity type:Individual
Prefix:MS
First Name:TABATHA
Middle Name:OPAL
Last Name:RAWAL
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:TABATHA
Other - Middle Name:
Other - Last Name:SHOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:2633 GOSLING WAY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76118-2035
Mailing Address - Country:US
Mailing Address - Phone:304-517-0296
Mailing Address - Fax:
Practice Address - Street 1:8100 PRECINCT LINE RD
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-7674
Practice Address - Country:US
Practice Address - Phone:682-244-4317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVC1689224Z00000X
TX116390225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant