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1235874165
IAN KEVIN GANNON
LUBBOCK, TX
NPI
1235874165
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: TX 241330)
Enumeration Date
2022-05-04
Last Update Date
2022-05-04
Business Address
IAN KEVIN GANNON COTA
4510 IRONTON AVE APT 12206
LUBBOCK, TX 79407-3816
Phone number: 806-577-6706
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Mailing Address
IAN KEVIN GANNON COTA
4403 74TH ST
LUBBOCK, TX 79424-2307
Phone number:
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