NPI 1952637076

Early Childhood Intervention

Organisation Early Intervention Provider Agency Fort Worth, TX

Practice location

Address: 5650 N Riverside Dr Suite 150, Fort Worth, TX 76137-2464
Phone: (682) 429-0556
Fax: (817) 569-5149
Mailing address: 3840 Hulen St, Fort Worth, TX 76107-7277

Authorised official

Name: Brenda Maughan Hamil
Title: Registered Nurse
Phone: (682) 429-0556

Registered specialties

Early Intervention Provider Agency Primary

Agencies Taxonomy 252Y00000X Licence 163W00000X (TX)

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Registry record

NPI: 1952637076
Entity type: Organization
NPI issued: 23 Oct 2009
Record last updated: 23 Oct 2009

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.