Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 120177 | TX |
NPI | 1598345506 |
---|---|
Provider Name | Jaclyn Jaci Miranda Robison |
First Address | Lakeway, TX 78734-4200 |
Second Address | Lakeway, TX 78734-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2021 |
Last Update Date | 13/04/2021 |