Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY 4415 | FL |
N | 103TC0700X | Clinical Psychologist | PY 4415 | FL |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PY 4415 | FL |
NPI | 1114123452 |
---|---|
Provider Name | John Jeffrey Oatley |
First Address | Daytona Beach, FL 32118-4016 |
Second Address | Daytona Beach, FL 32118-4016 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2007 |
Last Update Date | 08/07/2007 |