Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT21674 | FL |
NPI | 1003496886 |
---|---|
Provider Name | Jenna Michelle Ambrosio |
First Address | Delray Beach, FL 33482-8396 |
Second Address | Delray Beach, FL 33446-3808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2021 |
Last Update Date | 14/04/2021 |