Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 109177 | TX |
NPI | 1053777482 |
---|---|
Provider Name | Marilyn Barine |
First Address | Lewisville, TX 75077-2150 |
Second Address | Lewisville, TX 75077-2150 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/01/2016 |
Last Update Date | 14/01/2016 |