Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 109041 | TX |
NPI | 1154356079 |
---|---|
Provider Name | Jon F Blackburn |
First Address | Austin, TX 78746-5588 |
Second Address | Austin, TX 78746-5588 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 07/12/2007 |