Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 114375 | TX |
NPI | 1184903635 |
---|---|
Provider Name | Ms. Sherry Lynne Thom |
First Address | Georgetown, TX 78633-5451 |
Second Address | Georgetown, TX 78633-5723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 30/10/2013 |