Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 115875 | TX |
NPI | 1053841114 |
---|---|
Provider Name | Mrs. Audrey Michelle Frost |
First Address | Denison, TX 75020-1671 |
Second Address | Denison, TX 75020-1671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2017 |
Last Update Date | 12/06/2017 |