Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 111822 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1881175321 |
---|---|
Provider Name | Leena Ann Thomas |
First Address | Rockwall, TX 75087 |
Second Address | Rockwall, TX 75087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 13/12/2018 |