Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA9501 | FL |
NPI | 1003338229 |
---|---|
Provider Name | Jamie Deloris Whitson |
First Address | Homeland, FL 33847-0066 |
Second Address | Winter Haven, FL 33881-1432 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2017 |
Last Update Date | 10/07/2017 |