Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 111390 | TX |
NPI | 1053602144 |
---|---|
Provider Name | Katherine Ann Pitou |
First Address | Belton, TX 76513-1919 |
Second Address | Belton, TX 76513-1919 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2011 |
Last Update Date | 25/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
111390 | TX LICENSE (01) | TX |