Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 102870 | TX |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 102870 | TX |
NPI | 1306326830 |
---|---|
Provider Name | Ms. Trina Ann Bivens |
First Address | Port Arthur, TX 77640-2428 |
Second Address | Port Arthur, TX 77640-2428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2018 |
Last Update Date | 14/08/2018 |