Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 118245 | TX |
Y | 225XH1200X | Occupational Therapist - Hand | 118245 | TX |
NPI | 1184151847 |
---|---|
Provider Name | Adrian Bueno |
First Address | The Colony, TX 75056-2253 |
Second Address | The Colony, TX 75056-2253 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 01/04/2020 |