Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 104239 | TX |
NPI | 1063626208 |
---|---|
Provider Name | Kristin M. King |
First Address | Katy, TX 77450-5142 |
Second Address | Katy, TX 77450-5142 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2007 |
Last Update Date | 27/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8T1658 | BCBS (01) | TX |