Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 4031 | FL |
NPI | 1073740932 |
---|---|
Provider Name | Carolyn Tutt Willett |
First Address | St Petersburg, FL 33703-4412 |
Second Address | St Petersburg, FL 33703-4412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2009 |
Last Update Date | 18/06/2009 |