Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA15771 | FL |
NPI | 1003341421 |
---|---|
Provider Name | Angelica Polanco |
First Address | Weston, FL 33327-2443 |
Second Address | Weston, FL 33327-2443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2017 |
Last Update Date | 23/04/2017 |