Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA17268 | FL |
NPI | 1023645371 |
---|---|
Provider Name | Jeffrey Edward Royer |
First Address | Orlando, FL 32836-7622 |
Second Address | Winter Park, FL 32792-2244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2020 |
Last Update Date | 26/03/2020 |