Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 103372 | TX |
NPI | 1952882235 |
---|---|
Provider Name | Angela Darlene Adams |
First Address | Terrell, TX 75160-7372 |
Second Address | Mesquite, TX 75150-4048 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2018 |
Last Update Date | 24/08/2018 |