Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 119320 | TX |
NPI | 1033693502 |
---|---|
Provider Name | Doron Kantor |
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 | 20/09/2018 |
Last Update Date | 20/09/2018 |