Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP 44058 | TX |
N | 225CA2500X | Assistive Technology Supplier | ATP 44058 | TX |
NPI | 1851672562 |
---|---|
Provider Name | Mr. Kenneth Wayne Tindel |
First Address | Athens, TX 75751-5701 |
Second Address | Athens, TX 75751-5701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2011 |
Last Update Date | 08/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ATP 44058 | ASSISTIVE TECHNOLOGY PROFESSIONAL (01) | TX |