Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212317 | TX |
NPI | 1013498799 |
---|---|
Provider Name | Ms. Anne-Marie Fraser Kennedy |
First Address | Pipe Creek, TX 78063-4027 |
Second Address | Bandera, TX 78003-4765 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2018 |
Last Update Date | 22/08/2018 |