Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 208 452 | TX |
NPI | 1013366673 |
---|---|
Provider Name | Demetria Renae Sweatt-Phillips |
First Address | Denton, TX 76209-4679 |
Second Address | Denton, TX 76209-4679 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2016 |
Last Update Date | 12/07/2016 |