Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1724 | IL |
NPI | 1881780575 |
---|---|
Provider Name | Mrs. Nona W. Bickham |
First Address | Texarkana, TX 75503-3716 |
Second Address | Texarkana, AR 71854-1020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2006 |
Last Update Date | 26/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1724 | REGISTRATION (01) | IL |