Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT9378 | FL |
NPI | 1063593408 |
---|---|
Provider Name | Amy Stark |
First Address | Delray Beach, FL 33444-2969 |
Second Address | Coral Springs, FL 33065-4001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |