Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 116617 | TX |
NPI | 1437599974 |
---|---|
Provider Name | Mr. Scott James Thompson |
First Address | Dallas, TX 75211-1730 |
Second Address | Dallas, TX 75211-1730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2013 |
Last Update Date | 17/03/2018 |