Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212087 | TX |
NPI | 1023423019 |
---|---|
Provider Name | Samantha Anderson |
First Address | Hurst, TX 76053-7209 |
Second Address | Dallas, TX 75231-4395 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2014 |
Last Update Date | 27/06/2014 |