Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 114629 | TX |
NPI | 1134656523 |
---|---|
Provider Name | Ellen W Tan |
First Address | Sugar Land, TX 77479-3133 |
Second Address | Pearland, TX 77581-1006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2017 |
Last Update Date | 17/03/2018 |