Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 118715 | TX |
NPI | 1043778327 |
---|---|
Provider Name | Kelsey Tillett |
First Address | Paris, TX 75460-8015 |
Second Address | Paris, TX 75460-8015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/03/2019 |
Last Update Date | 06/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
118715 | TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS (01) | TX |