Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 105847 | TX |
NPI | 1316429087 |
---|---|
Provider Name | Constance Pugh Sheriff |
First Address | Corsicana, TX 75110-2869 |
Second Address | Corsicana, TX 75110-2869 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2018 |
Last Update Date | 30/08/2018 |