Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT18252 | FL |
NPI | 1093222820 |
---|---|
Provider Name | Janna Randolph |
First Address | Pensacola, FL 32503-2732 |
Second Address | Pensacola, FL 32503-2732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2018 |
Last Update Date | 02/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OT18252 | WORKER'S COMPENSATION (01) | FL |