Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 120716 | TX |
NPI | 1003436544 |
---|---|
Provider Name | Perla Paola Alcantara |
First Address | San Marcos, TX 78666-4496 |
Second Address | Dallas, TX 75254-8856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2020 |
Last Update Date | 27/04/2020 |