Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212254 | TX |
NPI | 1003396987 |
---|---|
Provider Name | Michelle Lee Gascot |
First Address | Garland, TX 75041-2904 |
Second Address | Garland, TX 75040-4104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 20/08/2018 |