Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 101979 | TX |
NPI | 1326401092 |
---|---|
Provider Name | Deborah Newcum |
First Address | Inez, TX 77968-3309 |
Second Address | Victoria, TX 77901-4546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 31/03/2016 |