Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 100733 | TX |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 100733 | TX |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 100733 | TX |
NPI | 1326515750 |
---|---|
Provider Name | Ms. Teresa Kay Carmack |
First Address | Smithville, TX 78957 |
Second Address | La Grange, TX 78945 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2018 |
Last Update Date | 24/10/2018 |