Individual
IAN KEVIN GANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
4510 IRONTON AVE APT 12206, LUBBOCK, TX 79407-3816
(806) 577-6706
Mailing address
4403 74TH ST, LUBBOCK, TX 79424-2307
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
241330
TX
Other
Enumeration date
05/04/2022
Last updated
05/04/2022
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