Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 210971 | TX |
NPI | 1013372150 |
---|---|
Provider Name | Shelly Steward |
First Address | Kingwood, TX 77345-2247 |
Second Address | Houston, TX 77056-1939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2015 |
Last Update Date | 16/12/2015 |