Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NX0100X | Occupational Health | DC4497 | TX |
N | 225400000X | Rehabilitation Practitioner | DC4497 | TX |
NPI | 1134136914 |
---|---|
Provider Name | Charles Ray Osborn |
First Address | Waxahachie, TX 75168-8597 |
Second Address | Waxahachie, TX 75165-4824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T15127 | (02) |