Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 110787 | TX |
NPI | 1316426208 |
---|---|
Provider Name | Deepa Moses |
First Address | Irving, TX 75060-4718 |
Second Address | Grand Prairie, TX 75050-5856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2018 |
Last Update Date | 10/08/2018 |