Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 018927-1 | NY |
Y | 225X00000X | Occupational Therapist | 21438 | FL |
N | 225X00000X | Occupational Therapist | 46TR00658800 | NJ |
N | 225XH1200X | Occupational Therapist - Hand | 16557 | CA |
NPI | 1174931729 |
---|---|
Provider Name | Garry Kovtun |
First Address | West Palm Beach, FL 33407-2040 |
Second Address | Lake Worth, FL 33467-6586 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2014 |
Last Update Date | 14/02/2022 |