Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 113487 | TX |
NPI | 1578042156 |
---|---|
Provider Name | Kimberly Niitzel |
First Address | Victoria, TX 77904-2553 |
Second Address | Cuero, TX 77954-2133 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 14/08/2018 |