Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 215350 | TX |
NPI | 1013492495 |
---|---|
Provider Name | Lorena Ruiz |
First Address | Pharr, TX 78577-6957 |
Second Address | Pharr, TX 78577-6957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2018 |
Last Update Date | 01/10/2018 |