Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 111062 | TX |
NPI | 1003221573 |
---|---|
Provider Name | Joyama Thomson |
First Address | Hurst, TX 76053-7209 |
Second Address | Dallas, TX 75247-4066 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/06/2014 |
Last Update Date | 24/06/2014 |