Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 107536 | TX |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 107536 | TX |
NPI | 1922110550 |
---|---|
Provider Name | Ms. Heather Elizabeth O'brien |
First Address | San Antonio, TX 78209-4867 |
Second Address | San Antonio, TX 78209-4867 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 21/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
75285003678239A007 | TRICARE (01) | TX |
8T0947 | BCBS (01) | TX |