Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 214248 | TX |
NPI | 1003116559 |
---|---|
Provider Name | Esther Fanning |
First Address | Harlingen, TX 78550-7930 |
Second Address | Harlingen, TX 78550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2010 |
Last Update Date | 13/08/2018 |