Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 15698 | FL |
NPI | 1326553785 |
---|---|
Provider Name | Jessica Mai Brown |
First Address | Tallahassee, FL 32309-2341 |
Second Address | Tallahassee, FL 32309-2341 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2017 |
Last Update Date | 07/12/2017 |