Provider Demographics
NPI:1437804036
Name:FENLEY, DOUGLAS EDWARD-MAXWELL (OTR)
Entity type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:EDWARD-MAXWELL
Last Name:FENLEY
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14651 DALLAS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-8856
Mailing Address - Country:US
Mailing Address - Phone:866-919-3240
Mailing Address - Fax:877-300-7394
Practice Address - Street 1:2104 E ANDERSON LN APT 524
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-1922
Practice Address - Country:US
Practice Address - Phone:866-919-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124775225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics