Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 213347 | TX |
NPI | 1013499789 |
---|---|
Provider Name | Channa Nowell |
First Address | San Angelo, TX 76901-1838 |
Second Address | San Angelo, TX 76904-7711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |