Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand |
NPI | 1215493465 |
---|---|
Provider Name | Dr. Dylan James O'connell |
First Address | Tampa, FL 33647-3255 |
Second Address | Tampa, FL 33618-2027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2019 |
Last Update Date | 13/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
19759 | OCCUPATIONAL THERAPY LICENSE (01) | FL |