Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 119120 | TX |
NPI | 1003390048 |
---|---|
Provider Name | Ms. Jessica Torres |
First Address | New Braunfels, TX 78130-2598 |
Second Address | Seguin, TX 78155-5101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2018 |
Last Update Date | 15/09/2018 |