Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 111427 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | 111427 | TX |
NPI | 1043322340 |
---|---|
Provider Name | Ms. Lynn Denise Athey |
First Address | San Antonio, TX 78258-3175 |
Second Address | San Antonio, TX 78239-1980 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
75285003678239A016 | TRICARE (01) | TX |
8T4103 | BCBS (01) | TX |