Provider Demographics
NPI:1730379181
Name:WOODWARD, THERESA DIANE (OTR)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:DIANE
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:DIANE
Other - Last Name:CHAMBERLAIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 932184
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-2184
Mailing Address - Country:US
Mailing Address - Phone:806-771-1040
Mailing Address - Fax:806-771-1040
Practice Address - Street 1:3016 INDEPENDENCE DR STE 201
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5461
Practice Address - Country:US
Practice Address - Phone:830-223-8309
Practice Address - Fax:830-321-0203
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109928225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist