Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP 52501 | TX |
NPI | 1184053258 |
---|---|
Provider Name | Mr. Raymond Yarbrough |
First Address | Lago Vista, TX 78645-8613 |
Second Address | Austin, TX 78751-1073 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2013 |
Last Update Date | 08/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ATP 52501 | RESNA (01) | TX |