Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA 15628 | FL |
NPI | 1023559119 |
---|---|
Provider Name | Danielle Sanders |
First Address | Orlando, FL 32819-4200 |
Second Address | Orlando, FL 32819-4200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2017 |
Last Update Date | 09/03/2017 |