Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 211081 | TX |
NPI | 1023374592 |
---|---|
Provider Name | Mrs. Glenda Darlene Dearman |
First Address | Sulphur, OK 73086-8813 |
Second Address | Sulphur, OK 73086-8813 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2012 |
Last Update Date | 09/04/2012 |