Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation |
NPI | 1285283689 |
---|---|
Provider Name | Kristopher Brown |
First Address | Jupiter, FL 33458-5832 |
Second Address | Lake Park, FL 33403-1954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2019 |
Last Update Date | 09/09/2019 |