Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 209699 | TX |
NPI | 1023234119 |
---|---|
Provider Name | Pamela Jean Lizotte |
First Address | New Braunfels, TX 78130 |
Second Address | Seguin, TX 78155-5129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |