Individual
MR. LOVEJOY IDAI MAKONI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
4201 STONEGATE BLVD, FORT WORTH, TX 76109-9503
(817) 924-5440
Mailing address
4201 STONEGATE BLVD, FORT WORTH, TX 76109-9503
(817) 924-5440
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
111373
TX
Other
Enumeration date
08/19/2018
Last updated
08/19/2018
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