Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 100846 | TX |
NPI | 1750968749 |
---|---|
Provider Name | Kathryn Cucolo |
First Address | San Antonio, TX 78231-2261 |
Second Address | San Antonio, TX 78231-2261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2021 |
Last Update Date | 25/03/2021 |