Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | SC |
NPI | 1003849696 |
---|---|
Provider Name | Jacquelyn Dawn Floyd |
First Address | Simpsonville, SC 29681-0369 |
Second Address | Greenville, SC 29607-5856 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 08/07/2007 |