Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 208367 | TX |
NPI | 1023627379 |
---|---|
Provider Name | Sandra Renee Perkins |
First Address | San Antonio, TX 78244-1778 |
Second Address | Austin, TX 78738-6891 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2020 |
Last Update Date | 23/07/2020 |