Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0144401 | NY |
NPI | 1063552131 |
---|---|
Provider Name | Katherine Ann Dos Santos |
First Address | Beaumont, TX 77708-3594 |
Second Address | Beaumont, TX 77707-4202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 19/12/2014 |