Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XP0200X | Occupational Therapist - Pediatrics |
NPI | 1023400033 |
---|---|
Provider Name | Lanna Koop |
First Address | Jacksonville, FL 32224-5663 |
Second Address | Jacksonville Beach, FL 32250-8002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2015 |
Last Update Date | 19/02/2021 |