Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT13813 | FL |
NPI | 1740517085 |
---|---|
Provider Name | Miss Mary Yantis Cooper |
First Address | Jacksonville, FL 32256-9664 |
Second Address | Jacksonville, FL 32256-9664 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2009 |
Last Update Date | 06/11/2009 |