Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 111219 | TX |
NPI | 1063662286 |
---|---|
Provider Name | Traci Bartz |
First Address | Dallas, TX 75284-7556 |
Second Address | Temple, TX 76502-1814 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 16/01/2012 |