Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT18593 | FL |
NPI | 1003307125 |
---|---|
Provider Name | Evan Jones |
First Address | Fort Pierce, FL 34982-5637 |
Second Address | Fort Pierce, FL 34982-5637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2018 |
Last Update Date | 24/05/2018 |