Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 110011 | TX |
NPI | 1003413592 |
---|---|
Provider Name | Raymond Bryan Ruwaldt II |
First Address | Houston, TX 77080-5520 |
Second Address | Houston, TX 77024-3800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2020 |
Last Update Date | 07/10/2020 |