Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 108803 | TX |
NPI | 1215412895 |
---|---|
Provider Name | Mrs. Poonam Mehta |
First Address | Dallas, TX 75254-7805 |
Second Address | Dallas, TX 75254-7805 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2018 |
Last Update Date | 28/09/2018 |