Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology |
NPI | 1811470081 |
---|---|
Provider Name | Michael Alvarez |
First Address | Webster, TX 77598-4206 |
Second Address | Webster, TX 77598-4206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2018 |
Last Update Date | 12/09/2018 |