Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 209212 | TX |
NPI | 1003978172 |
---|---|
Provider Name | Angela Chavando |
First Address | Easton, PA 18040-7958 |
Second Address | Round Rock, TX 78664-9323 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |