Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 105374 | TX |
Y | 225XH1200X | Occupational Therapist - Hand | 105374 | TX |
NPI | 1164541876 |
---|---|
Provider Name | Lea Etta Riddiough Gilbert |
First Address | Arlington, TX 76012-4758 |
Second Address | Arlington, TX 76012-4758 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 25/04/2008 |