Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212873 | TX |
NPI | 1023598554 |
---|---|
Provider Name | Kristen Rubine |
First Address | Austin, TX 78745-2223 |
Second Address | Austin, TX 78748-3614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2018 |
Last Update Date | 15/08/2018 |