Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | OT12279 | FL |
NPI | 1023162526 |
---|---|
Provider Name | Miss Brandee Renee Swan |
First Address | Orlando, FL 32814-6429 |
Second Address | Maitland, FL 32751-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2007 |
Last Update Date | 09/07/2007 |