Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 117365 | TX |
NPI | 1639798960 |
---|---|
Provider Name | Jacqueline M Lauder |
First Address | Dallas, TX 75234-7385 |
Second Address | Dallas, TX 75234-7385 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2020 |
Last Update Date | 16/04/2020 |