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Individual

AILEEN DOSDOS TANCHAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2320 LAKE SHORE DR, WACO, TX 76708-1276
(254) 752-1075
Mailing address
2917 PUEBLO DR, WACO, TX 76712-8381

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
111435
TX

Other

Enumeration date
08/19/2018
Last updated
08/19/2018
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