Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician | ||
Y | 225XP0200X | Occupational Therapist - Pediatrics | 305452 | TX |
NPI | 1033778840 |
---|---|
Provider Name | Jisan Lim |
First Address | Flower Mound, TX 75028-7429 |
Second Address | Flower Mound, TX 75028-7429 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2019 |
Last Update Date | 28/01/2022 |