Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 108447 | TX |
NPI | 1356608756 |
---|---|
Provider Name | Nicole Warren |
First Address | Weatherford, TX 76085-3651 |
Second Address | Weatherford, TX 76085-3651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2012 |
Last Update Date | 23/04/2012 |