Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 114169 | TX |
NPI | 1003101445 |
---|---|
Provider Name | Griselda Blanco |
First Address | Rio Grande City, TX 78582-6168 |
Second Address | Rio Grande City, TX 78582-9552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2011 |
Last Update Date | 18/08/2020 |