Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT16152 | FL |
NPI | 1275084485 |
---|---|
Provider Name | Jessica Becton |
First Address | Atlanta, GA 31193-1306 |
Second Address | Santa Rosa Beach, FL 32459-7198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2016 |
Last Update Date | 24/10/2016 |