Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 119565 | TX |
NPI | 1982223038 |
---|---|
Provider Name | Mckenzie Daniell |
First Address | Anna, TX 75409-8459 |
Second Address | Dallas, TX 75219-7840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2020 |
Last Update Date | 09/04/2020 |