Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225CA2400X | Assistive Technology Practitioner | ATP47963 | TX |
NPI | 1265790513 |
---|---|
Provider Name | Mr. Reed Wells |
First Address | Amarillo, TX 79106-2514 |
Second Address | Amarillo, TX 79106-2514 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2012 |
Last Update Date | 15/08/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
189016207 | (05) | TX |
189016208 | (05) | TX |