Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 116916 | TX |
NPI | 1043681703 |
---|---|
Provider Name | Teresa Alejandra Chavez |
First Address | Temple, TX 76502-5888 |
Second Address | Temple, TX 76504-7062 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2015 |
Last Update Date | 03/12/2018 |