Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT4792 | FL |
NPI | 1851631311 |
---|---|
Provider Name | Luz E. Valle |
First Address | Fort Pierce, FL 34979-3445 |
Second Address | Fort Pierce, FL 34945-2503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2013 |
Last Update Date | 20/02/2013 |