Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 209858 | TX |
NPI | 1023296860 |
---|---|
Provider Name | Courtney Ruiz |
First Address | Center, TX 75935-3921 |
Second Address | Mccomb, MS 39648-3926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2008 |
Last Update Date | 04/02/2008 |