Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 5254 | FL |
NPI | 1619374279 |
---|---|
Provider Name | Emmeral Jones |
First Address | Bradenton, FL 34208-2616 |
Second Address | Bradenton, FL 34208-2616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/11/2014 |
Last Update Date | 25/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT 5254 | FL CERTIFICATION (01) | FL |