Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OTA 11515 | FL |
NPI | 1619248408 |
---|---|
Provider Name | Melissa Governale |
First Address | Sanford, FL 32771-8333 |
Second Address | Sanford, FL 32771-8333 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2012 |
Last Update Date | 25/01/2012 |