Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | ||
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1659852523 |
---|---|
Provider Name | Lenny Nazareno Morejon Garzon |
First Address | The Woodlands, TX 77381-4335 |
Second Address | Conroe, TX 77304 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2018 |
Last Update Date | 28/08/2018 |