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General NPI Number Information
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NPI Number | 1457827933
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Entity Type | Individual
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Provider Name | DYNA A JOSE
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Gender | Female
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Dates
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Enumeration Date | 10/22/2018
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Last Update Date | 10/22/2018
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Provider Practice Location Address
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Address Line | 915 W EXCHANGE PKWY STE 100
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City | ALLEN
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State | TX
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Zip | 75013-7018
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Country | US
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Telephone | 214-547-1571
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 WHITESTONE LN APT 122
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City | PLANO
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State | TX
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Zip | 75024-3033
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Country | US
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Telephone | 201-989-7577
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 113815
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License Number State | TX
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