Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT6424 | FL |
Y | 225XM0800X | Mental Health | 113405 | TX |
NPI | 1760679989 |
---|---|
Provider Name | Mariateresa Gomez-Lansidel |
First Address | Kingwood, TX 77339-1014 |
Second Address | Houston, TX 77030-4211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2007 |
Last Update Date | 29/06/2010 |