Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 16266 | FL |
NPI | 1023516937 |
---|---|
Provider Name | Michael Torres |
First Address | Davie, FL 33328-1101 |
Second Address | Sunrise, FL 33323-3207 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2018 |
Last Update Date | 25/01/2018 |