Individual
MR. MARK ANTHONY SOLOMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
5242 MEDICAL LODGE DR, ROCKWALL, TX 75032-7503
(972) 772-8700
Mailing address
5242 MEDICAL LODGE DR, ROCKWALL, TX 75032
(972) 772-8700
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
213197
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
81420021
—
TX
Enumeration date
08/24/2018
Last updated
08/24/2018
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