Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 215539 | TX |
NPI | 1023679347 |
---|---|
Provider Name | Comfort Obeleagu |
First Address | Richmond, TX 77407-2297 |
Second Address | Richmond, TX 77407-2297 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 26/06/2019 |