Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1083079834 |
---|---|
Provider Name | Jean Morissaint |
First Address | Orlando, FL 32822-4818 |
Second Address | Orlando, FL 32822-4818 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2015 |
Last Update Date | 21/12/2015 |