Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OTA12121 | FL |
NPI | 1073041968 |
---|---|
Provider Name | Mr. Antoine Dwight Dobson |
First Address | Newberry, FL 32669-2938 |
Second Address | Gainesville, FL 32605-4213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2017 |
Last Update Date | 23/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12 | (05) | FL |