Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 208422 | TX |
NPI | 1083195325 |
---|---|
Provider Name | Carol A Minchew |
First Address | Round Rock, TX 78664-3935 |
Second Address | Georgetown, TX 78626-7725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2018 |
Last Update Date | 24/08/2018 |