Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 116878 | TX |
NPI | 1144700014 |
---|---|
Provider Name | Mary Grace Lim Ong |
First Address | Amarillo, TX 79106-3700 |
Second Address | Amarillo, TX 79106-3700 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 20/08/2018 |