Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 205024 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1265914766 |
---|---|
Provider Name | Audra Traugott |
First Address | La Vernia, TX 78121-4734 |
Second Address | La Vernia, TX 78121-4734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |