Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT18996 | FL |
NPI | 1073278693 |
---|---|
Provider Name | Mary Chadwick |
First Address | Orlando, FL 32835-8064 |
Second Address | Orlando, FL 32835-8064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2021 |
Last Update Date | 08/11/2021 |