Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 10227 | FL |
NPI | 1003919663 |
---|---|
Provider Name | Heather Dawn Moening |
First Address | Melbourne, FL 32904-3874 |
Second Address | Melbourne, FL 32901-2625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10227 | OCCT THERAPIST ASSIST (01) | FL |