Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 112101 | TX |
NPI | 1003131400 |
---|---|
Provider Name | Mrs. Christina Joanne Bennett |
First Address | Austin, TX 78732-1204 |
Second Address | Austin, TX 78732-1204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2010 |
Last Update Date | 28/09/2020 |