Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 216461 | TX |
NPI | 1003413782 |
---|---|
Provider Name | Gabriela Coronado Lopez |
First Address | Humble, TX 77396-4136 |
Second Address | Humble, TX 77396-4136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2020 |
Last Update Date | 05/10/2020 |