Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | 109317 | TX |
Y | 225XG0600X | Occupational Therapist - Gerontology | 109317 | TX |
NPI | 1447592944 |
---|---|
Provider Name | Mrs. Miquel Christine Canny |
First Address | Spring, TX 77379-4995 |
Second Address | Spring, TX 77379-4968 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2013 |
Last Update Date | 22/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109317 | (02) | TX |