Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT5339 | FL |
NPI | 1003155144 |
---|---|
Provider Name | Mark Ngambwa Ndege |
First Address | Port Saint Lucie, FL 34986-3638 |
Second Address | Port Saint Lucie, FL 34986-3638 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2013 |
Last Update Date | 09/02/2013 |