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Individual

AILEEN TAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2401 20TH ST, LUBBOCK, TX 79411-1003
(806) 780-4180
Mailing address
2401 20TH ST, LUBBOCK, TX 79411-1003
(806) 780-4180

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
110410
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
331042299
TX
Enumeration date
02/21/2013
Last updated
02/25/2013
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