Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 0119005365 | VA |
N | 225X00000X | Occupational Therapist | 017570 | NY |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 117102 | TX |
NPI | 1043578412 |
---|---|
Provider Name | Diana S Chang |
First Address | Killeen, TX 76541-8918 |
Second Address | Killeen, TX 76542-6249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 01/09/2015 |