Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 102238 | TX |
NPI | 1003086620 |
---|---|
Provider Name | Mrs. Evelyn Marie Harness |
First Address | San Antonio, TX 78229-4801 |
Second Address | San Antonio, TX 78229-4801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2008 |
Last Update Date | 11/03/2008 |