Individual
SANDRA LEE THACKERAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1726 BOWLER RD, WALLER, TX 77484-9646
(281) 620-9077
Mailing address
1726 BOWLER RD, WALLER, TX 77484-9646
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
21793606
TX
Other
Enumeration date
11/19/2009
Last updated
11/19/2009
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