Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 214175 | TX |
NPI | 1811458383 |
---|---|
Provider Name | Mr. Theodore Morgan JR. |
First Address | Fort Worth, TX 76102-3400 |
Second Address | Fort Worth, TX 76102-3400 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 27/03/2019 |