Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 114750 | TX |
NPI | 1700489440 |
---|---|
Provider Name | Mary A Anderson |
First Address | Spring, TX 77379-6537 |
Second Address | Spring, TX 77379-6537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2020 |
Last Update Date | 17/11/2020 |