Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 004817 | TX |
NPI | 1164848776 |
---|---|
Provider Name | Sandy De Vries |
First Address | Mesquite, TX 75150-6926 |
Second Address | Mesquite, TX 75150-6926 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2014 |
Last Update Date | 07/03/2014 |