Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 2044640 | TX |
NPI | 1023280369 |
---|---|
Provider Name | Maribel T Fuller |
First Address | Easton, PA 18040-7958 |
Second Address | Katy, TX 77450-1779 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2008 |
Last Update Date | 27/03/2008 |