Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT 2674 | FL |
N | 225XH1200X | Occupational Therapist - Hand | OT 2674 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT 2674 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT 2674 | FL |
NPI | 1235172859 |
---|---|
Provider Name | Barbara Annette Divincenzo |
First Address | Deland, FL 32720-2560 |
Second Address | Deland, FL 32720-2560 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT 2674 | STATE LICENSE (01) | FL |
Z6251 | BLUE CROSS & BLUE SHIELD (01) | FL |