Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA14045 | FL |
NPI | 1013430669 |
---|---|
Provider Name | Jessica Christina De La Torre |
First Address | Miami, FL 33145-2934 |
Second Address | Miami, FL 33145-2934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 25/07/2017 |