Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 18970 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | 18970 |
NPI | 1003317413 |
---|---|
Provider Name | Hannah Stark |
First Address | Tampa, FL 33607-5999 |
Second Address | Venice, FL 34292 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2018 |
Last Update Date | 17/08/2018 |