Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA18075 | FL |
NPI | 1013599208 |
---|---|
Provider Name | Andrew Tangkeko |
First Address | Kissimmee, FL 34743-8610 |
Second Address | Kissimmee, FL 34743-8610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2021 |
Last Update Date | 27/04/2021 |