Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 114124 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 114124 | TX |
NPI | 1285145276 |
---|---|
Provider Name | Mrs. Laura Pekala |
First Address | Frisco, TX 75035-7707 |
Second Address | Frisco, TX 75034-1181 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/10/2017 |
Last Update Date | 17/10/2017 |