Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 112078 | TX |
NPI | 1003052564 |
---|---|
Provider Name | Kelsey Renae James |
First Address | Conroe, TX 77301-4136 |
Second Address | Conroe, TX 77301-4136 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 05/01/2009 |