Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 101606 | TX |
NPI | 1003396169 |
---|---|
Provider Name | Wanda G Taylor |
First Address | Beaumont, TX 77707-2549 |
Second Address | Beaumont, TX 77707-2549 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2018 |
Last Update Date | 17/08/2018 |