Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | OT12952 | FL |
NPI | 1003463068 |
---|---|
Provider Name | Kimberly Anne Pogue |
First Address | Lakeland, FL 33803-2884 |
Second Address | Lakeland, FL 33805-2225 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2019 |
Last Update Date | 23/08/2019 |