Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 113546 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 007023 | OH |
NPI | 1851629612 |
---|---|
Provider Name | Jurden Pasilan |
First Address | Tyler, TX 75701-9603 |
Second Address | Winnsboro, TX 75494-3226 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2009 |
Last Update Date | 11/06/2019 |