Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA 10348 | FL |
NPI | 1013306299 |
---|---|
Provider Name | Mr. Andrew Todd Wilhelm |
First Address | Panama City Beach, FL 32413-2328 |
Second Address | Panama City Beach, FL 32413-2328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2015 |
Last Update Date | 12/01/2015 |