Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 103133 | TX |
NPI | 1861034985 |
---|---|
Provider Name | Mrs. Linda Ann Mullenix |
First Address | League City, TX 77573-5985 |
Second Address | League City, TX 77573-5985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2019 |
Last Update Date | 09/10/2019 |