Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 11816 | MA |
N | 225XG0600X | Occupational Therapist - Gerontology | OT5215 | FL |
NPI | 1871958850 |
---|---|
Provider Name | Eve Bergantino |
First Address | Spring Hill, FL 34608-2946 |
Second Address | Spring Hill, FL 34608-2946 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/12/2015 |
Last Update Date | 17/12/2015 |