Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 1100073 | TX |
NPI | 1205270055 |
---|---|
Provider Name | Alisa M Sandoval |
First Address | Dallas, TX 75228-5838 |
Second Address | Dallas, TX 75228-5838 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2013 |
Last Update Date | 23/04/2013 |