Individual
MRS. BREANA FAYE GOUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 926-2544
Mailing address
424 SUGARTREE DR, LIPAN, TX 76462-9609
(432) 270-8177
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
TX
Other
Enumeration date
01/04/2021
Last updated
01/04/2021
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