Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 214112 | TX |
NPI | 1023567633 |
---|---|
Provider Name | Jacqueline Loyola |
First Address | Jacksonville, TX 75766-4630 |
Second Address | Tyler, TX 75702 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2016 |
Last Update Date | 23/09/2016 |