Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT12712 | FL |
NPI | 1851542070 |
---|---|
Provider Name | Angela Stowers |
First Address | Melbourne, FL 32901-3122 |
Second Address | Melbourne, FL 32901-3122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/10/2008 |
Last Update Date | 07/10/2008 |