Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT11525 | FL |
N | 225XG0600X | Occupational Therapist - Gerontology | OT11525 | FL |
N | 225XL0004X | Low Vision | OT11525 | FL |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | OT11525 | FL |
N | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OT11525 | FL |
NPI | 1649446774 |
---|---|
Provider Name | Kelly Ann Graham |
First Address | Pompano Beach, FL 33060-7164 |
Second Address | Pompano Beach, FL 33060-7164 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2008 |
Last Update Date | 20/11/2019 |