Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | ||
Y | 225XP0200X | Occupational Therapist - Pediatrics | FL |
NPI | 1013426915 |
---|---|
Provider Name | Kyla Kimberly Sharrah |
First Address | St Augustine, FL 32086-5283 |
Second Address | Jacksonville, FL 32256-2006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2017 |
Last Update Date | 22/09/2017 |