Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 111618 | TX |
NPI | 1003230822 |
---|---|
Provider Name | Mrs. Sue Khammar |
First Address | Fort Worth, TX 76116-8122 |
Second Address | Fort Worth, TX 76116-8122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2014 |
Last Update Date | 13/02/2014 |