Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 117134 | TX |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 117134 | TX |
Y | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1861021701 |
---|---|
Provider Name | Kendra Brett Loftice Roberts |
First Address | Ravenna, TX 75476-7003 |
Second Address | Howe, TX 75459-4538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2020 |
Last Update Date | 01/02/2022 |