Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212537 | TX |
NPI | 1003450768 |
---|---|
Provider Name | Ladonna Sorenson |
First Address | Texarkana, TX 75503-3523 |
Second Address | Texarkana, TX 75503-3523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2019 |
Last Update Date | 05/11/2019 |