Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP49799 |
NPI | 1104216886 |
---|---|
Provider Name | Mr. Edmund Case Horton |
First Address | Stephenville, TX 76401 |
Second Address | Stephenville, TX 76401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2015 |
Last Update Date | 02/02/2015 |