Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XF0002X | Feeding, Eating & Swallowing | OT3692 | FL |
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT 3692 | FL |
NPI | 1659575074 |
---|---|
Provider Name | Jane Reale |
First Address | Pensacola, FL 32507-7721 |
Second Address | Pensacola, FL 32507-7721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2007 |
Last Update Date | 02/12/2008 |