Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA13429 | FL |
NPI | 1023642956 |
---|---|
Provider Name | Brittany Creech Thompson |
First Address | Jennings, FL 32053-2650 |
Second Address | Lake City, FL 32025-5614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2020 |
Last Update Date | 01/03/2020 |