Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT21030 | FL |
N | 225XF0002X | Feeding, Eating & Swallowing | OT21030 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT21030 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT21030 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT21030 | FL |
NPI | 1588241509 |
---|---|
Provider Name | Brittany Nicole Bodenbender |
First Address | Saint Augustine, FL 32084-0008 |
Second Address | St Augustine, FL 32086-5179 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2021 |
Last Update Date | 25/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT21030 | STATE LICENSE NUMBER (01) | FL |