Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 213929 | TX |
NPI | 1598246654 |
---|---|
Provider Name | Minerva L Marsh |
First Address | Milford, TX 76670-1140 |
Second Address | Comanche, TX 76442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2018 |
Last Update Date | 27/08/2018 |