Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | OT8440 | FL |
Y | 225XG0600X | Occupational Therapist - Gerontology | OT8440 | FL |
NPI | 1518938877 |
---|---|
Provider Name | Marla Sue Popkin |
First Address | Inverness, FL 34452-4824 |
Second Address | Inverness, FL 34452-4824 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U1175 | (02) | FL |