Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 209423 | TX |
NPI | 1396316659 |
---|---|
Provider Name | Michelle Marie Hewitt |
First Address | Gordon, TX 76453-3868 |
Second Address | Fort Worth, TX 76102-3425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2021 |
Last Update Date | 08/07/2021 |