Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 110407 | TX |
NPI | 1508911066 |
---|---|
Provider Name | Mary Anne Davis |
First Address | Richardson, TX 75080-5623 |
Second Address | Richardson, TX 75080-5623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2007 |
Last Update Date | 12/12/2007 |