Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 214875 | TX |
NPI | 1013496686 |
---|---|
Provider Name | Ceara Rose Edwards |
First Address | Austin, TX 78752-3950 |
Second Address | Elgin, TX 78621-1528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 14/08/2018 |