Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 111673 | TX |
N | 225XG0600X | Occupational Therapist - Gerontology | 111673 | TX |
NPI | 1285933309 |
---|---|
Provider Name | Mrs. Priscilla Despain |
First Address | Plano, TX 75024 |
Second Address | Waxahachie, TX 75165-2770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/03/2011 |
Last Update Date | 16/03/2011 |