Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 204160 | TX |
NPI | 1023598737 |
---|---|
Provider Name | Patricia Marie Eagle |
First Address | Columbus, TX 78934-1421 |
Second Address | Eagle Lake, TX 77434-3001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |