Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 105358 | TX |
NPI | 1962792663 |
---|---|
Provider Name | Mrs. Katie Vivian Metheny |
First Address | Dallas, TX 75246-1713 |
Second Address | Dallas, TX 75246-1713 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2011 |
Last Update Date | 14/04/2011 |