Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 108963 | TX |
NPI | 1396084745 |
---|---|
Provider Name | Jayanthi Subramanian |
First Address | Dallas, TX 75287-4923 |
Second Address | Dallas, TX 75287-4923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2013 |
Last Update Date | 05/02/2013 |