Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 413521 | TX |
NPI | 1013481415 |
---|---|
Provider Name | Marissa-Li Garrett |
First Address | Round Rock, TX 78664-7900 |
Second Address | West Plains, MO 65775-2028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2019 |
Last Update Date | 18/01/2019 |