Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 111796 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 111796 | TX |
NPI | 1790094910 |
---|---|
Provider Name | Josefina Charles |
First Address | Laredo, TX 78045-6526 |
Second Address | Laredo, TX 78041 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2010 |
Last Update Date | 17/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1714362-01 | (05) | TX |
45-4858 | (02) | TX |