Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter |
NPI | 1427521871 |
---|---|
Provider Name | Rhonda Marie Mahan |
First Address | Midland, TX 79705-2326 |
Second Address | Midland, TX 79705-2326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2019 |
Last Update Date | 08/01/2019 |