Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 121871 | TX |
NPI | 1003484916 |
---|---|
Provider Name | Danyelle Braelyn Huffaker |
First Address | Avoca, TX 79503-2121 |
Second Address | Fort Worth, TX 76116-3802 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2021 |
Last Update Date | 16/06/2021 |