Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 121678 | TX |
NPI | 1326719212 |
---|---|
Provider Name | Jessica Arias |
First Address | College Station, TX 77845-8487 |
Second Address | Bryan, TX 77802-5214 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 21/09/2021 |