Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 119142 | TX |
NPI | 1003305004 |
---|---|
Provider Name | Nicole Manigeh Ahmadi |
First Address | Stafford, TX 77477-2836 |
Second Address | Katy, TX 77450-5898 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2018 |
Last Update Date | 04/05/2018 |