Provider Demographics
NPI:1871906164
Name:FOUNTAIN, LINDA (OTA)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:OTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:305 NE LOOP 820
Mailing Address - Street 2:BUSINESS TOWER1 , SUITE 200
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7209
Mailing Address - Country:US
Mailing Address - Phone:817-292-8787
Mailing Address - Fax:817-789-6849
Practice Address - Street 1:3120 SOUTHWEST FWY
Practice Address - Street 2:SUITE 612
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-4509
Practice Address - Country:US
Practice Address - Phone:713-979-3800
Practice Address - Fax:713-979-3806
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX205583224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant