Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OP006569 | PA |
NPI | 1033377197 |
---|---|
Provider Name | Julieann Phares |
First Address | San Antonio, TX 78232-3740 |
Second Address | San Antonio, TX 78232-3740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 27/05/2008 |