Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | OTA9798 | FL |
NPI | 1023382777 |
---|---|
Provider Name | Mr. Bret Eugene Williams |
First Address | Tavares, FL 32778-9611 |
Second Address | Tavares, FL 32778-9611 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2012 |
Last Update Date | 28/02/2012 |