Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 115307 | TX |
NPI | 1245578145 |
---|---|
Provider Name | Casey Marlene Ingram |
First Address | Midlothian, TX 76065-5597 |
Second Address | Midlothian, TX 76065-5591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2013 |
Last Update Date | 20/08/2021 |