Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 32487 | FL |
NPI | 1023590916 |
---|---|
Provider Name | Michelle Chiribogajorgensen |
First Address | Orlando, FL 32825-8521 |
Second Address | Orlando, FL 32825-8521 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2018 |
Last Update Date | 06/09/2018 |