Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 211423 | TX |
NPI | 1013388594 |
---|---|
Provider Name | Mrs. Diane Marie Lobue |
First Address | Hurst, TX 76053-7209 |
Second Address | Houston, TX 77060-1240 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2015 |
Last Update Date | 09/10/2015 |