Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 231735 | TX |
NPI | 1598248817 |
---|---|
Provider Name | Mrs. Karen Arnetta Primm |
First Address | Mexia, TX 76667-2887 |
Second Address | Waco, TX 76710-5558 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2018 |
Last Update Date | 12/09/2018 |