Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 21957 | FL |
NPI | 1043886617 |
---|---|
Provider Name | Jazmine Joy-Ann Theodore |
First Address | Winter Park, FL 32789-1990 |
Second Address | Oviedo, FL 32765-8895 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2021 |
Last Update Date | 03/06/2021 |