Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 118175 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 118175 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | 118175 | TX |
NPI | 1891060679 |
---|---|
Provider Name | Latara Hart |
First Address | Grand Prairie, TX 75054-1885 |
Second Address | Arlington, TX 76010-6926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2012 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
404282201 | (05) | TX |