Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 118204 | TX |
NPI | 1184165839 |
---|---|
Provider Name | Rachel D Hazlewood |
First Address | Kingwood, TX 77339-3862 |
Second Address | Kingwood, TX 77339-3862 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2017 |
Last Update Date | 14/03/2017 |