Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 210149 | TX |
NPI | 1023406568 |
---|---|
Provider Name | Adam Joseph Mignery |
First Address | Rosenberg, TX 77471-8544 |
Second Address | Rosenberg, TX 77471-5712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2015 |
Last Update Date | 07/01/2015 |