Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 106912 | TX |
N | 225XH1200X | Occupational Therapist - Hand | 106912 | TX |
NPI | 1255399390 |
---|---|
Provider Name | Emily Elizabeth Fontana |
First Address | Austin, TX 78752-3842 |
Second Address | Austin, TX 78752-3842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2006 |
Last Update Date | 24/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00X977 | MEDICARE GROUP TPAN (01) | TX |