Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225400000X | Rehabilitation Practitioner | ATP 7744 | TX |
N | 225CA2400X | Assistive Technology Practitioner | ATP 7744 | TX |
N | 225CA2500X | Assistive Technology Supplier | ATP 7744 | TX |
N | 225CX0006X | Orientation and Mobility Training Provider | ATP 7744 | TX |
NPI | 1407254964 |
---|---|
Provider Name | Brent Eenigenburg |
First Address | Sherman, TX 75090-5707 |
Second Address | Sherman, TX 75090-5707 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2014 |
Last Update Date | 06/05/2020 |