Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1023770104 |
---|---|
Provider Name | Bailee Elaine Bunnell |
First Address | Lubbock, TX 79410 |
Second Address | Lubbock, TX 79410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2021 |
Last Update Date | 06/10/2021 |