Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 110267 | TX |
NPI | 1023488947 |
---|---|
Provider Name | Mrs. Brandi Nelson |
First Address | Keller, TX 76248-7331 |
Second Address | Keller, TX 76248-7331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 05/10/2015 |