Basic Information
| Provider Information | |||||||||
| NPI: | 1023406568 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MIGNERY | ||||||||
| FirstName: | ADAM | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4121 KUNZ RD | ||||||||
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| City: | ROSENBERG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774718544 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 3010 BAMORE RD | ||||||||
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| City: | ROSENBERG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774715712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813422142 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2015 | ||||||||
| LastUpdateDate: | 01/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 210149 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.