Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 105862 | TX |
NPI | 1285841569 |
---|---|
Provider Name | Lori L. Elias |
First Address | Dallas, TX 75206-5588 |
Second Address | Dallas, TX 75246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 17/07/2018 |