Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212295 | IN |
NPI | 1003437815 |
---|---|
Provider Name | Charlita Tillman |
First Address | Cypress, TX 77433-1745 |
Second Address | Houston, TX 77054-4032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2020 |
Last Update Date | 04/05/2020 |