Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 204565 | TX |
NPI | 1003962101 |
---|---|
Provider Name | Melissa Aguayo Salazar |
First Address | Laredo, TX 78041-5434 |
Second Address | Laredo, TX 78041-5434 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
204565 | LICENSE (01) | TX |