Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 117154 | TX |
NPI | 1558842542 |
---|---|
Provider Name | Haylee Taylor Little |
First Address | Orange, TX 77630-7657 |
Second Address | Beaumont, TX 77707-5019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |