Provider Demographics
NPI:1871072439
Name:OGNOWSKI, DUSTIN (COTA, DOR)
Entity type:Individual
Prefix:
First Name:DUSTIN
Middle Name:
Last Name:OGNOWSKI
Suffix:
Gender:M
Credentials:COTA, DOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 HIGHWAY 71 E APT 1212
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-4655
Mailing Address - Country:US
Mailing Address - Phone:512-662-4898
Mailing Address - Fax:
Practice Address - Street 1:907 GARWOOD ST
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957-1117
Practice Address - Country:US
Practice Address - Phone:512-237-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212877224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212877OtherTEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS