Basic Information
| Provider Information | |||||||||
| NPI: | 1871073726 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MORELAND | ||||||||
| FirstName: | LETITIA | ||||||||
| MiddleName: | D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16700 FM 2186 | ||||||||
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| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791196731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8064417339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2611 SW 46TH AVE | ||||||||
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| City: | AMARILLO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 791101735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8063556517 | ||||||||
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| ProviderEnumerationDate: | 08/20/2018 | ||||||||
| LastUpdateDate: | 08/20/2018 | ||||||||
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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 | 225X00000X | 108882 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.