Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 209922 | TX |
NPI | 1013498740 |
---|---|
Provider Name | Vickie Mendoza |
First Address | Wylie, TX 75098-8776 |
Second Address | Wylie, TX 75098-8776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |