Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 104023 | TX |
NPI | 1508346354 |
---|---|
Provider Name | Mrs. Carole D Vinton |
First Address | Murphy, TX 75094-4479 |
Second Address | Dallas, TX 75238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 24/08/2018 |