Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 12623 | FL |
NPI | 1003256751 |
---|---|
Provider Name | Joni Irwin |
First Address | Merritt Island, FL 32953-2923 |
Second Address | Merritt Island, FL 32953-2923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2013 |
Last Update Date | 26/06/2013 |