Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 207999 | TX |
NPI | 1003128273 |
---|---|
Provider Name | Brett Harold Gerberman |
First Address | Houston, TX 77067-1956 |
Second Address | Houston, TX 77067-1956 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2010 |
Last Update Date | 05/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
207999 | COTA LICENSE (01) | TX |