Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 112683 | TX |
NPI | 1366950974 |
---|---|
Provider Name | Lydia Abigael Indimuli |
First Address | Houston, TX 77065-4242 |
Second Address | Houston, TX 77065-4242 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2018 |
Last Update Date | 17/01/2018 |