Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 210218 | TX |
NPI | 1023588316 |
---|---|
Provider Name | Jacklyn Williams |
First Address | Pflugerville, TX 78660-5454 |
Second Address | Georgetown, TX 78626-7725 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2018 |
Last Update Date | 28/11/2018 |