Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 212749 | TX |
NPI | 1003322439 |
---|---|
Provider Name | Skyla Burd Biesecker |
First Address | Lubbock, TX 79424-1311 |
Second Address | Lubbock, TX 79424-1311 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2017 |
Last Update Date | 21/12/2017 |