Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 214851 |
NPI | 1013484732 |
---|---|
Provider Name | Mrs. Morgan Nicole Peden Judice |
First Address | Lumberton, TX 77657-1172 |
Second Address | Kountze, TX 77625-7804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2018 |
Last Update Date | 31/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
214851 | TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS (01) | TX |