Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | 110625 | TX |
NPI | 1780720300 |
---|---|
Provider Name | Ms. Tracie P. Fey |
First Address | Robstown, TX 78380-5365 |
Second Address | Corpus Christi, TX 78404-2235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |