Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist |
NPI | 1003169707 |
---|---|
Provider Name | Miss Cecily Claire Brasseur |
First Address | Fpo, AP 96362-1600 |
Second Address | Fpo, AP 96362-1600 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2012 |
Last Update Date | 18/10/2012 |