Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 214922 | TX |
NPI | 1023675956 |
---|---|
Provider Name | Sheila Denise Johnson-Travis |
First Address | Columbus, TX 78934-2149 |
Second Address | Columbus, TX 78934-1537 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2019 |
Last Update Date | 27/05/2019 |