Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 208785 | TX |
NPI | 1013495829 |
---|---|
Provider Name | Mrs. Melissa M. Cavazos |
First Address | La Feria, TX 78559-1965 |
Second Address | Los Fresnos, TX 78566-3635 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2018 |
Last Update Date | 02/08/2018 |