Provider Demographics
NPI:1538621941
Name:WELCH, JODIE BYBEE (MOT,LOT)
Entity type:Individual
Prefix:
First Name:JODIE
Middle Name:BYBEE
Last Name:WELCH
Suffix:
Gender:F
Credentials:MOT,LOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 W DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:BLOSSOM
Mailing Address - State:TX
Mailing Address - Zip Code:75416-2733
Mailing Address - Country:US
Mailing Address - Phone:409-539-1184
Mailing Address - Fax:
Practice Address - Street 1:740 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:BLOSSOM
Practice Address - State:TX
Practice Address - Zip Code:75416-2733
Practice Address - Country:US
Practice Address - Phone:409-539-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX114237225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics