Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 206458 | TX |
NPI | 1003395336 |
---|---|
Provider Name | Marsha G Trietsch |
First Address | Grand Prairie, TX 75050-5856 |
Second Address | Grand Prairie, TX 75050-5856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2018 |
Last Update Date | 08/08/2018 |