Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 109631 | TX |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 109631 | TX |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 109631 | TX |
NPI | 1932272283 |
---|---|
Provider Name | Mr. Jason Lynn Stark |
First Address | Houston, TX 77009-7100 |
Second Address | Spring, TX 77379-5803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 15/04/2011 |