Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 115447 | TX |
N | 225XF0002X | Feeding, Eating & Swallowing | 115447 | TX |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 115447 | TX |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 115447 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | 115447 | TX |
NPI | 1801231063 |
---|---|
Provider Name | Dr. Laura Elizabeth Golden |
First Address | Fort Worth, TX 76107-7277 |
Second Address | Fort Worth, TX 76119-8111 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2013 |
Last Update Date | 13/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
317945902 | (05) | TX |
8FAZ34 | YOUR BLUE CROSS BLUE SHIELD (01) | TX |