Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 119114 | TX |
NPI | 1003395740 |
---|---|
Provider Name | Dat Nguyen |
First Address | Pearland, TX 77584-7741 |
Second Address | Webster, TX 77598-6701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2018 |
Last Update Date | 13/08/2018 |