Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 100355 | TX |
NPI | 1184735888 |
---|---|
Provider Name | Mr. Eugene A Constantine |
First Address | Longview, TX 75605-5143 |
Second Address | Longview, TX 75605-5143 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |