Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT16190 | FL |
NPI | 1427570191 |
---|---|
Provider Name | Crystal Hutauruk |
First Address | Orlando, FL 32810-1760 |
Second Address | Orlando, FL 32804-1331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2017 |
Last Update Date | 13/07/2017 |