Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 103432 | TX |
N | 225XE0001X | Environmental Modification | 103432 | TX |
N | 225XF0002X | Feeding, Eating & Swallowing | 103432 | TX |
N | 2251H1300X | Human Factors | 103432 | TX |
N | 225XH1300X | Human Factors | 103432 | TX |
N | 225XL0004X | Low Vision | 103432 | TX |
N | 225XM0800X | Mental Health | 103432 | TX |
N | 225XP0200X | Occupational Therapist - Pediatrics | 103432 | TX |
NPI | 1003149832 |
---|---|
Provider Name | Trisel Michelle Davis |
First Address | Richmond, TX 77469-4471 |
Second Address | Richmond, TX 77469-4471 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2009 |
Last Update Date | 12/09/2009 |