Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT1472 | FL |
N | 225XG0600X | Occupational Therapist - Gerontology | OT1472 | FL |
N | 225XP0200X | Occupational Therapist - Pediatrics | OT1472 | FL |
NPI | 1689168973 |
---|---|
Provider Name | Lynne Block-Hickock |
First Address | Largo, FL 33773-2511 |
Second Address | Largo, FL 33773-2511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2018 |
Last Update Date | 19/06/2018 |