Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT9498 | FL |
NPI | 1265892590 |
---|---|
Provider Name | John Paul Conroy |
First Address | Orange Park, FL 32065-4254 |
Second Address | Jacksonville, FL 32244-6668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2016 |
Last Update Date | 29/02/2016 |