Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 105821 | TX |
N | 225XH1200X | Occupational Therapist - Hand | ||
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1013191428 |
---|---|
Provider Name | Mrs. Susan E. Andre |
First Address | Bedford, TX 76021 |
Second Address | Bedford, TX 76021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2007 |
Last Update Date | 10/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
TXB115376 | MEDICARE PTAN (01) | TX |