Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 209314 | TX |
NPI | 1023599511 |
---|---|
Provider Name | Shelly Ruth Mcintyre |
First Address | Avinger, TX 75630-1700 |
Second Address | Mt Pleasant, TX 75455-6744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2018 |
Last Update Date | 23/08/2018 |