Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 208891 | TX |
NPI | 1003370933 |
---|---|
Provider Name | Juanita Martha Ortiz |
First Address | Laredo, TX 78046-5101 |
Second Address | Laredo, TX 78041-6410 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2019 |
Last Update Date | 24/01/2019 |