Individual
MARY ANN NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 CROWN POINTE BLVD, WILLOW PARK, TX 76087-1160
(817) 757-1200
Mailing address
300 CROWN POINTE BLVD, WILLOW PARK, TX 76087-1160
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213508
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
213508
—
TX
Enumeration date
09/15/2018
Last updated
09/15/2018
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