Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 104041 | TX |
NPI | 1811420094 |
---|---|
Provider Name | Lori Matthews |
First Address | Fort Worth, TX 76112-1553 |
Second Address | Fort Worth, TX 76112-1553 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2017 |
Last Update Date | 05/04/2017 |