Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 119177 | TX |
NPI | 1003395880 |
---|---|
Provider Name | Taffta Thornburgh |
First Address | Spring, TX 77381-3075 |
Second Address | Spring, TX 77381-3075 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2018 |
Last Update Date | 12/08/2018 |