Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP5470 | TX |
NPI | 1033498043 |
---|---|
Provider Name | John David Deeds |
First Address | Hurst, TX 76053-4633 |
Second Address | Hurst, TX 76053-4633 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2011 |
Last Update Date | 08/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142593601 | (05) | TX |