Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 1923 | TN |
NPI | 1003421413 |
---|---|
Provider Name | Berenice Maria Sansone |
First Address | Lakeland, TN 38002-4685 |
Second Address | Lakeland, TN 38002-4685 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2020 |
Last Update Date | 11/09/2020 |