Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 17667 | FL |
NPI | 1023624566 |
---|---|
Provider Name | Corey Kevin Colby |
First Address | Plant City, FL 33567-2662 |
Second Address | Lakeland, FL 33805-3008 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2020 |
Last Update Date | 21/09/2020 |