Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 120167 | TX |
NPI | 1215511597 |
---|---|
Provider Name | Lauren Carson |
First Address | Shenandoah, TX 77380-2608 |
Second Address | Shenandoah, TX 77380-2683 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2021 |
Last Update Date | 12/05/2021 |