Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OC015888 | PA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 119988 | TX |
NPI | 1043781883 |
---|---|
Provider Name | Kaylyn Andress |
First Address | Killeen, TX 76541-8918 |
Second Address | Killeen, TX 76542 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2018 |
Last Update Date | 10/07/2019 |