Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 121172 | TX |
NPI | 1003423344 |
---|---|
Provider Name | Samantha Sweet |
First Address | Dallas, TX 75254-2512 |
Second Address | Dallas, TX 75254-2512 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2020 |
Last Update Date | 30/09/2020 |