Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 056.008601 | IL |
Y | 225X00000X | Occupational Therapist | OT12723 | FL |
N | 225XH1200X | Occupational Therapist - Hand | OT12723 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT12723 |
NPI | 1083809230 |
---|---|
Provider Name | Douglas Jerome Winter |
First Address | Orlando, FL 32836 |
Second Address | Orlando, FL 32836 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2007 |
Last Update Date | 03/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
892547000 | (05) | FL |