Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 110055 | TX |
NPI | 1205836665 |
---|---|
Provider Name | Melissa Blake James |
First Address | Fort Worth, TX 76104-3155 |
Second Address | Fort Worth, TX 76104-3155 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2005 |
Last Update Date | 31/03/2009 |