Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 116090 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 116090 | TX |
NPI | 1851873673 |
---|---|
Provider Name | Mary May Guevarra |
First Address | Killeen, TX 76542-6053 |
Second Address | Bangs, TX 76823-3232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2018 |
Last Update Date | 29/08/2018 |