Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP62519 | TX |
NPI | 1538505482 |
---|---|
Provider Name | Brandon Fry |
First Address | Plano, TX 75093-3876 |
Second Address | Richardson, TX 75081-7207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2013 |
Last Update Date | 20/05/2013 |