Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 109844 | TX |
NPI | 1194206672 |
---|---|
Provider Name | Kent Stahl |
First Address | Glen Rose, TX 76043-4937 |
Second Address | Glen Rose, TX 76043-4937 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |