Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA5964 | FL |
NPI | 1013235878 |
---|---|
Provider Name | Dale Stanley |
First Address | Bradenton, FL 34208 |
Second Address | Bradenton, FL 34208-5890 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2010 |
Last Update Date | 04/05/2010 |