Individual
MODESTY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
716 MIMOSA DR, MINEOLA, TX 75773-2612
(903) 569-5366
Mailing address
1909 SHILOH RD APT 52, TYLER, TX 75703-2630
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213950
TX
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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