Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 305431 | TX |
NPI | 1003489436 |
---|---|
Provider Name | Brianna Nicole Reyna |
First Address | Mcallen, TX 78504-9768 |
Second Address | Mcallen, TX 78504-3104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2021 |
Last Update Date | 22/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
305431 | OT (01) | TX |