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General NPI Number Information
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NPI Number | 1831388925
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Entity Type | Individual
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Provider Name | JOSPHAT WANJUKI GIKONYO I OCCUPATIONAL THERAPY
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Gender | Male
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 03/05/2019
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Provider Practice Location Address
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Address Line | 700 S OSTROM AVE
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City | EASTLAND
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State | TX
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Zip | 76448-3226
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Country | US
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Telephone | 254-629-1779
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Fax |
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Provider Business Mailing Address
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Address Line | 807 EARLY BLVD
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City | EARLY
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State | TX
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Zip | 76802-2130
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Country | US
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Telephone | 325-200-2805
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 109662
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License Number State | TX
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