Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 109093 | TX |
NPI | 1013019298 |
---|---|
Provider Name | Miss Angie M Hawkins |
First Address | Longview, TX 75605-5143 |
Second Address | Longview, TX 75605-5143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 08/07/2007 |