Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT 4177 | FL |
NPI | 1942556980 |
---|---|
Provider Name | Mr. Barry Altman |
First Address | Palm Coast, FL 32137-1464 |
Second Address | Palm Coast, FL 32137-1464 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2012 |
Last Update Date | 27/07/2012 |