Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 109585 | TX |
NPI | 1407257363 |
---|---|
Provider Name | Mr. John Jefferson Linn JR. |
First Address | Louisville, KY 40202-2407 |
Second Address | Houston, TX 77025-1534 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 10/09/2014 |