Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | 10296600 | TX |
NPI | 1215229687 |
---|---|
Provider Name | Michael Lang Polley |
First Address | Tyler, TX 75701-0405 |
Second Address | Tyler, TX 75701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 16/08/2018 |