Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 208964 | TX |
Y | 225X00000X | Occupational Therapist | 118877 | TX |
NPI | 1023245297 |
---|---|
Provider Name | Rosie Isela Vallejo |
First Address | Mcallen, TX 78504-5730 |
Second Address | Mcallen, TX 78501-5263 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2009 |
Last Update Date | 16/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3796575 | (05) | TX |