Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 4488 | FL |
NPI | 1467782698 |
---|---|
Provider Name | Craig C Weston |
First Address | Boynton Beach, FL 33436-1834 |
Second Address | Lantana, FL 33462-6431 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2010 |
Last Update Date | 11/01/2010 |