Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225CA2400X | Assistive Technology Practitioner | 91528 | TX |
NPI | 1003581455 |
---|---|
Provider Name | Alex Kenneth Gottleaber |
First Address | Fort Worth, TX 76199-1383 |
Second Address | Fort Worth, TX 76104-1025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2021 |
Last Update Date | 24/11/2021 |