Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 119223 | TX |
NPI | 1043790181 |
---|---|
Provider Name | Lauren Nicole Beaudoin |
First Address | San Antonio, TX 78230-4820 |
Second Address | San Antonio, TX 78230-4820 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |