Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 113292 | TX |
NPI | 1710467600 |
---|---|
Provider Name | Ms. Jane L Osborne |
First Address | San Angelo, TX 76903-4077 |
Second Address | San Angelo, TX 76903-4077 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2018 |
Last Update Date | 20/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
113292 | TEXAS BOARD OF OCCUPATIONAL THERAPY EXAMINERS (01) | TX |
225342 | AMERICAN OCCUPATIONAL THERAPY ASSOCIATION (01) | AZ |