Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 117399 | TX |
NPI | 1063173995 |
---|---|
Provider Name | Blaire Surley |
First Address | Fort Worth, TX 76132-6108 |
Second Address | Fort Worth, TX 76132-6108 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2022 |
Last Update Date | 03/01/2022 |