Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT0002149 | FL |
NPI | 1053551358 |
---|---|
Provider Name | Jennifer Fleming |
First Address | North Miami, FL 33181-2901 |
Second Address | North Miami, FL 33181-2901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2009 |
Last Update Date | 04/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110416300 | (05) | FL |