Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 113026 | TX |
NPI | 1063654333 |
---|---|
Provider Name | Hallie C Archer |
First Address | Austin, TX 78703-2009 |
Second Address | Killeen, TX 76542-6249 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 01/04/2009 |