Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 208173 | TX |
NPI | 1003370123 |
---|---|
Provider Name | Elizabeth Poppell |
First Address | San Antonio, TX 78230-4711 |
Second Address | San Antonio, TX 78230-4711 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2019 |
Last Update Date | 23/01/2019 |