Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TM1800X | Intellectual & Developmental Disabilities | ||
N | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1770010290 |
---|---|
Provider Name | Julie Chambers |
First Address | Frisco, TX 75034-1905 |
Second Address | Frisco, TX 75034-1905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2017 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TX12-531282 | BOARD OF COGNITIVE REHABILITATION (01) | TX |