Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT003526 | GA |
Y | 225XH1200X | Occupational Therapist - Hand |
NPI | 1255311049 |
---|---|
Provider Name | Mr. Anthony Dale Papp I |
First Address | West Lake Hills, TX 78746-5463 |
Second Address | Austin, TX 78759-4107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2006 |
Last Update Date | 18/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013262 | NBCOT OT LICENSE-NATIONAL (01) | |
OT003526 | OT LICENSE (01) | GA |