Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 110820 | TX |
N | 225XE0001X | Environmental Modification | 110820 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 110820 | TX |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 110820 | TX |
NPI | 1285948711 |
---|---|
Provider Name | Kathleen Leslie Ballee |
First Address | Austin, TX 78750-8160 |
Second Address | Austin, TX 78750-8160 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2010 |
Last Update Date | 26/07/2010 |