Basic Information
| Provider Information | |||||||||
| NPI: | 1093295206 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GREBER | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | ROLLEIGH | ||||||||
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| Credential: | COTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4804 WILLOW RUN CT | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761321518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188347980 | ||||||||
| FaxNumber: | 3188347980 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 HUGULEY BLVD | ||||||||
| Address2: | |||||||||
| City: | BURLESON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760287506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175515900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2018 | ||||||||
| LastUpdateDate: | 08/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 214368 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.