Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XL0004X | Low Vision | OT11688 | FL |
NPI | 1104153188 |
---|---|
Provider Name | Kate Niles Lines |
First Address | Sarasota, FL 34231-3622 |
Second Address | Sarasota, FL 34231-3622 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2009 |
Last Update Date | 11/11/2009 |