Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1275156218 |
---|---|
Provider Name | Courtney Martin |
First Address | Fort Worth, TX 76120-7000 |
Second Address | Fort Worth, TX 76120-7000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2020 |
Last Update Date | 26/05/2020 |