Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0T0697 | FL |
NPI | 1073820502 |
---|---|
Provider Name | Jodi Brunsvold |
First Address | Wellington, FL 33449-7406 |
Second Address | Wellington, FL 33449-7406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2010 |
Last Update Date | 03/09/2010 |