Individual
ANQUANETTE EVETTE NETHERLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
611 NW STALLINGS DR, NACOGDOCHES, TX 75964-3847
(936) 564-1138
Mailing address
PO BOX 1467, CENTER, TX 75935-1467
(936) 564-1138
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
210097
TX
Other
Enumeration date
08/22/2018
Last updated
08/22/2018
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