Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 210307 | TX |
NPI | 1023589645 |
---|---|
Provider Name | Lisa Darlene Cavanaugh |
First Address | Amarillo, TX 79106-4137 |
Second Address | Amarillo, TX 79106-4137 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2018 |
Last Update Date | 07/12/2018 |