Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 110285 | TX |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 110285 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | 110285 | TX |
NPI | 1952463945 |
---|---|
Provider Name | Mrs. Kelly Lisbethrollins Tiemann |
First Address | Houston, TX 77035-4916 |
Second Address | Houston, TX 77074-5200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2006 |
Last Update Date | 08/07/2007 |