Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 119485 | TX |
NPI | 1033557996 |
---|---|
Provider Name | Mr. John David Ferguson |
First Address | Denison, TX 75020-1671 |
Second Address | Denison, TX 75020 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2013 |
Last Update Date | 06/03/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
119485 | TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS (01) | TX |