Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT12537 | FL |
NPI | 1003037268 |
---|---|
Provider Name | Carina Quiambao |
First Address | Gotha, FL 34734-5064 |
Second Address | Ocoee, FL 34761-8970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT12537 | OCCUPATIONAL THERAPY LICE (01) | FL |