Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | 1923 | TX |
NPI | 1447738273 |
---|---|
Provider Name | Dara Breanne Spivey |
First Address | Dallas, TX 75235-5386 |
Second Address | Dallas, TX 75235-5386 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2018 |
Last Update Date | 02/08/2018 |