Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | TX |
NPI | 1649752809 |
---|---|
Provider Name | Jamy Suzanne Sanders |
First Address | Longview, TX 75605-2302 |
Second Address | Longview, TX 75605-2461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2018 |
Last Update Date | 04/09/2018 |