Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 10025OTA | FL |
NPI | 1003300807 |
---|---|
Provider Name | Angel Gabriel |
First Address | Defuniak Springs, FL 32435-8629 |
Second Address | Gulf Breeze, FL 32563-3351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2018 |
Last Update Date | 15/06/2018 |