Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 107005 | TX |
NPI | 1003944240 |
---|---|
Provider Name | Lauren Stoddart |
First Address | Bryan, TX 77805-4588 |
Second Address | Bryan, TX 77803-5303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005330801 | (05) | TX |