Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 114718 | TX |
NPI | 1164902243 |
---|---|
Provider Name | Diep H Nguyen |
First Address | Garland, TX 75040-0973 |
Second Address | Garland, TX 75040-8502 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |