Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 103249 | TX |
N | 225XH1200X | Occupational Therapist - Hand | 103249 | TX |
NPI | 1023074036 |
---|---|
Provider Name | Gail Blom |
First Address | Plano, TX 75093 |
Second Address | Plano, TX 75093 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 28/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4724960001 | PALMETTO GBA DMERC (01) | TX |
8T0248 | BLUE CROSS BLUE SHIELD (01) | TX |
P75007 | (02) |