Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA16885 | FL |
NPI | 1003387598 |
---|---|
Provider Name | Danielle E Mikell |
First Address | Saint Petersburg, FL 33714-3451 |
Second Address | Bradenton, FL 34209-4602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 10/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CNA306608 | CNA (01) | FL |
OTA16885 | OCCUPATIONAL THERAPY ASSISTANT (01) | FL |