Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 116116 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | OTR 1614 | AR |
NPI | 1023167855 |
---|---|
Provider Name | Mrs. Terra Anita Brown |
First Address | Keller, TX 76248-3876 |
Second Address | Keller, TX 76248-3876 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2007 |
Last Update Date | 16/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
142612721 | (05) | AR |