Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 113450 | TX |
NPI | 1053633214 |
---|---|
Provider Name | Amber J Reiss |
First Address | Porter, TX 77365-0009 |
Second Address | Porter, TX 77365-5416 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/02/2010 |
Last Update Date | 15/02/2010 |